| NPI | 1407143126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTA R JOHNSON Sole Member 505-860-7512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: KY 4271) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: IN 22004153A) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2015-04-18 |