Basic Information
| Provider Information | |||||||||
| NPI: | 1346610508 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | TRISHA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 35 | ||||||||
| Address2: | |||||||||
| City: | LAUGHLINTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156550035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143667568 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3950 WILLIAM PENN HWY | ||||||||
| Address2: | |||||||||
| City: | MURRYSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156681870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245197722 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 05/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL012972 | PA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SZ6939 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.