Individual
REBECCA SUZANNA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2605 MURRAY AVE, TIFTON, GA 31794-2822
(229) 392-0363
Mailing address
2605 MURRAY AVE, TIFTON, GA 31794-2822
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSLP.0000292
DORA LICENSE COLORADO (PROVISIONAL)
CO
Enumeration date
09/01/2017
Last updated
09/01/2017
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