Provider Demographics
NPI:1487385944
Name:JOHNSON, CHALLIE M (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:CHALLIE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7931 W 55TH AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-3704
Mailing Address - Country:US
Mailing Address - Phone:605-770-9405
Mailing Address - Fax:
Practice Address - Street 1:23830 COUNTY ROAD 48
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:CO
Practice Address - Zip Code:80645-8612
Practice Address - Country:US
Practice Address - Phone:970-451-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPLSP.0000967235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist