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 |