Basic Information
| Provider Information | |||||||||
| NPI: | 1306892120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | LARRIMORE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.S., CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2420 SHALLEY DR | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323093019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508935720 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1607 SAINT JAMES CT | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508780191 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AUD003611 | GA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.