Provider Demographics
NPI:1447657747
Name:JOHNSON, VALERIE (MED, CCC/SP)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED, CCC/SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BROADWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-5552
Mailing Address - Country:US
Mailing Address - Phone:781-643-6090
Mailing Address - Fax:781-643-7395
Practice Address - Street 1:37 BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-5552
Practice Address - Country:US
Practice Address - Phone:781-643-6090
Practice Address - Fax:781-643-7395
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA722235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist