Provider Demographics
NPI:1043684731
Name:JOHANSING, ELLEN (CCC-SLP, MS)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:JOHANSING
Suffix:
Gender:F
Credentials:CCC-SLP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 MONTANA ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78203-1164
Mailing Address - Country:US
Mailing Address - Phone:415-317-1194
Mailing Address - Fax:
Practice Address - Street 1:8600 WURZBACH RD STE 700
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4332
Practice Address - Country:US
Practice Address - Phone:210-737-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115218235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist