Individual
SARA B JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
4935 HILLEGAS RD, FORT WAYNE, IN 46818-1934
(260) 338-1241
Mailing address
4935 HILLEGAS RD, FORT WAYNE, IN 46818-1934
(260) 338-1241
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22003600A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200670630
—
IN
05
—
200849350
—
IN
Enumeration date
05/01/2007
Last updated
10/02/2018
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