Individual
MRS. SANDRA GAYLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
749 DRISKILL DRIVE, RICHMOND, MO 64085
(816) 776-5838
Mailing address
1306 JILL LANE, EXCELSIOR SPRINGS, MO 64024
(816) 630-5751
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
463521203
—
MO
Enumeration date
09/01/2015
Last updated
09/01/2015
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