Individual
CONNIE M. JOHANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSCCCSLP
Contact information
Practice address
2403 BATTLEFIELD PKWY, FORT OGLETHORPE, GA 30742-4033
(706) 866-7700
Mailing address
1119 GNOME TRL, LOOKOUT MTN, GA 30750-2811
(706) 820-7622
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP001627
GA
Other
Enumeration date
11/07/2006
Last updated
07/08/2007
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