| NPI | 1972370674 |
|---|---|
| Former Name | STACY JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA 617193H) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CO 24429412) |
| Enumeration Date | 2023-12-04 |
| Last Update Date | 2025-08-11 |