Provider Demographics
NPI:1851276000
Name:JOHNSON, KELLIE ANN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:ANN
Other - Last Name:DEUTSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:2616 N RIDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-4211
Mailing Address - Country:US
Mailing Address - Phone:316-558-2585
Mailing Address - Fax:
Practice Address - Street 1:2616 N RIDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-4211
Practice Address - Country:US
Practice Address - Phone:316-558-2585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14301570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist