Active NPI
Lori Johnson, SLP
- Speech-Language Pathologist
- Pine Bluff, AR
National Provider Identifier
1104971860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP847
- Practice address
- 2915 S Hazel St
Pine Bluff, AR 71603-5008 - Phone
- (870) 535-0010
- NPI assigned
- Jan 24, 2007
- Last updated
- Jul 9, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP847 | AR | Primary |
Addresses
Primary practice location
2915 S Hazel St
Pine Bluff, AR 71603-5008
Mailing address
707 Eldridge Ave E
Wynne, AR 72396-4032
Phone (870) 208-8989
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5X209 | Other | AR | BLUE CROSS & BLUE SHIELD |
| 01120253 | Other | AR | ASHA ACCOUNT NUMBER |
| 126867721 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP847 | AR | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boaz & Associates, Inc. | Past | Accepting new patients |
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": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1104971860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 ELDRIDGE AVE E",
"city": "WYNNE",
"state": "AR",
"postal_code": "723964032",
"telephone_number": "870-208-8989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2915 S HAZEL ST",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "716035008",
"telephone_number": "870-535-0010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "LORI",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AR",
"license": "SP847",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS & BLUE SHIELD",
"identifier": "5X209",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHA ACCOUNT NUMBER",
"identifier": "01120253",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "126867721",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pine Bluff, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.