Individual
LYDIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2522 E 70TH ST, SHREVEPORT, LA 71105-4002
(713) 594-9726
Mailing address
2522 E 70TH ST, SHREVEPORT, LA 71105-4002
(713) 594-9726
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6422
LA
Other
Enumeration date
06/22/2016
Last updated
11/15/2016
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