NPI | 1083036578 |
---|---|
Former Name | JESSICA ANNE JOHNSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL sa15873) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NJ 41YS00613900) |
Enumeration Date | 2014-01-17 |
Last Update Date | 2023-05-05 |