Basic Information
| Provider Information | |||||||||
| NPI: | 1861456907 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | ELISA | ||||||||
| MiddleName: | ORTIZ | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15106 N CUSTER LN | ||||||||
| Address2: | |||||||||
| City: | MEAD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990219016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094674612 | ||||||||
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| Practice Location | |||||||||
| Address1: | 711 S COWLEY ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992021330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094736000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | LL00002843 | WA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.