Provider Demographics
NPI:1295062529
Name:JOHNSTON, JESSICA ANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:JOHNSTON
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 1:3129 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLS
Mailing Address - State:NY
Mailing Address - Zip Code:13812-3224
Mailing Address - Country:US
Mailing Address - Phone:607-206-6542
Mailing Address - Fax:
Practice Address - Street 1:3129 E RIVER RD
Practice Address - Street 2:
Practice Address - City:NICHOLS
Practice Address - State:NY
Practice Address - Zip Code:13812-3224
Practice Address - Country:US
Practice Address - Phone:607-206-6542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYSL0080362355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant