Provider Demographics
NPI:1558037598
Name:JOHNSON, JENNIFER ROSE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ROSE
Other - Last Name:KLEINKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:804 SERVICE RD STE A202
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-3070
Mailing Address - Fax:517-884-1817
Practice Address - Street 1:909 WILSON RD STE B119
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-6410
Practice Address - Country:US
Practice Address - Phone:517-353-3070
Practice Address - Fax:517-884-1817
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101006983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist