Provider Demographics
NPI:1447546742
Name:JOHNSON, ALICE MARIE (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4544 INTERSTATE 10 E
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-8881
Mailing Address - Country:US
Mailing Address - Phone:281-420-4800
Mailing Address - Fax:
Practice Address - Street 1:4544 INTERSTATE 10 E
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-8881
Practice Address - Country:US
Practice Address - Phone:281-420-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104449235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist