Provider Demographics
NPI:1174743652
Name:JOHNSON, ERIN MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
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 1:1201 OFFICE PARK RD
Mailing Address - Street 2:#111
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2405
Mailing Address - Country:US
Mailing Address - Phone:515-664-2866
Mailing Address - Fax:
Practice Address - Street 1:1201 OFFICE PARK RD
Practice Address - Street 2:#111
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2405
Practice Address - Country:US
Practice Address - Phone:515-664-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist