| 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 |