Provider Demographics
NPI:1063027043
Name:JOHNSON, MARISA LYNNE COZINE
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:LYNNE COZINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:LYNNE
Other - Last Name:COZINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2703 LAURELCREST CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-8134
Mailing Address - Country:US
Mailing Address - Phone:224-532-7425
Mailing Address - Fax:
Practice Address - Street 1:2703 LAURELCREST CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8134
Practice Address - Country:US
Practice Address - Phone:224-532-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist