Individual
MRS. DEBRA SMANDA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
1021 SOUTHPORT DR, LAFAYETTE, IN 47909-6111
(765) 477-6569
Mailing address
1021 SOUTHPORT DR, LAFAYETTE, IN 47909-6111
(765) 477-6569
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22001286A
IN
Other
Enumeration date
04/09/2019
Last updated
04/09/2019
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