Provider Demographics
NPI:1871980490
Name:JOHNSON, ANNA MARIA (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PRIVATEER DR
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1933
Mailing Address - Country:US
Mailing Address - Phone:415-758-7104
Mailing Address - Fax:
Practice Address - Street 1:30 PRIVATEER DR
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1933
Practice Address - Country:US
Practice Address - Phone:415-758-7104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 10419235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist