Basic Information
| Provider Information | |||||||||
| NPI: | 1770968992 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | ANASTASIA | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 HOLCOMBE BLVD 34L | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770212041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328281289 | ||||||||
| FaxNumber: | 8328258740 | ||||||||
| Practice Location | |||||||||
| Address1: | 9700 BISSONNET ST | ||||||||
| Address2: | STE 1000W | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770368001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328281005 | ||||||||
| FaxNumber: | 8328259461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2015 | ||||||||
| LastUpdateDate: | 08/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 111077 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.