Individual provider Active NPI

Chase Johnson

  • Speech-Language Pathologist
  • Fargo, ND
National Provider Identifier
1083209977
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
4152 30TH Ave S
Fargo, ND 58104-8524
Phone
(701) 364-9070
Fax
(701) 364-9071
NPI assigned
Mar 3, 2021
Last updated
Jan 15, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X ND Primary

Addresses

Primary practice location

4152 30TH Ave S
Fargo, ND 58104-8524

Mailing address

2200 20TH St SW
Jamestown, ND 58401-7500
Phone (701) 252-3850

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250507001897 ND Practitioner - Qualified Speech Language Pathologist 1052838653 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Anne Carlsen Center Behavior Analyst CurrentSince Feb 28, 2025 Accepting new patients

Locations

2800 Main Ave
Fargo, ND 58103
Phone (701) 364-2663

4152 30th Ave S
Fargo, ND 58104
Phone (701) 364-2663

2016 S Washington St
Grand Forks, ND 58201
Phone (701) 757-4200

2200 20th St SW
Jamestown, ND 58401
Phone (701) 252-3850

701 3rd St NW
Jamestown, ND 58401
Phone (701) 252-3850

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1083209977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 20TH ST SW",
            "city": "JAMESTOWN",
            "state": "ND",
            "postal_code": "584017500",
            "telephone_number": "701-252-3850",
            "fax_number": "701-952-1450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4152 30TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048524",
            "telephone_number": "701-364-9070",
            "fax_number": "701-364-9071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CHASE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-03",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ND",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.