Jessica Marie Johnson, AUD
Individual provider Active NPI Audiologist · McClellan, CA
NPI 1003335423 · NPPES record last updated Jul 30, 2019
Key facts
- NPI
- 1003335423
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Audiologist 231H00000X
- License
- SLP-AU-LIC-6628 (MT)
- Practice address
- 5342 Dudley Blvd # 95652
McClellan, CA 95652-1012 - Phone
- (916) 561-7400
- NPI assigned
- Sep 18, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP-AU-LIC-6628 | MT | MD | Audiologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | SLP-AU-LIC-6628 | MT | Yes |
Addresses
Primary practice location
5342 Dudley Blvd # 95652
McClellan, CA 95652-1012
Mailing address
5342 Dudley Blvd # 95652
McClellan, CA 95652-1012
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jessica.johnson10@va.gov |
Other providers in McClellan, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.