Individual
ELYSE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
602 VONDERBURG DR, SUITE 201, BRANDON, FL 33511-5900
(813) 653-1149
(813) 654-6644
Mailing address
602 VONDERBURG DR, SUITE 201, BRANDON, FL 33511-5900
(813) 653-1149
(813) 654-6644
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SZ5989
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006713100
—
FL
Enumeration date
09/20/2012
Last updated
10/24/2012
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