Individual
KELBY LANE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2121 45TH ST APT 3412, HIGHLAND, IN 46322-0007
(832) 260-1309
Mailing address
2121 45TH ST APT 3412, HIGHLAND, IN 46322-0007
(832) 260-1309
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
242005176
IL
Other
Enumeration date
12/21/2018
Last updated
12/21/2018
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