Kimberly Anne Johnson, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

18242 Issued in OR

Practice address

593 NW York Dr
Bend, OR 97703-7264

Phone

(971) 346-0355

NPI assigned

Sep 3, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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

• Speechworks LLC

  • Speech-Language Pathologist
  • Lake Oswego, OR
  • NPI 1922746619
  NPD (past)
• Chatterbox Pediatric Therapy

  • Speech-Language Pathologist
  • Nampa, ID
  • NPI 1972423556
  NPD (past)

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

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1114531480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "593 NW YORK DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 NW YORK DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037264",
            "telephone_number": "971-346-0355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KIMBERLY",
        "middle_name": "ANNE",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-03",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ID",
            "license": "TSLP-4434",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OR",
            "license": "18242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey J. Johnson, D.D.S.
• Jenna Rae Johnson, LCSW
• Jennifer Clark Johnson, OTR/L
• Joel Allen Johnson, NP-BC
• Kendall M Johnson
• Kristina Anne Johnson, RN
• Kylie R. Johnson, CRM
• Lindsey James Johnson, LCSW
• Linsey Sharianne Johnson, LD, RDN
• Lisa Johnson

• Speech-Language Pathologist in Bend, OR
• Providers in Bend, OR by specialty
• Speech-Language Pathologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.