Johanna Linnea Bozeman, M.ED., CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Villa Rica, GA
NPI 1154052041 · NPPES record last updated Jun 19, 2026
Key facts
- NPI
- 1154052041
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SLP012557 (GA)
- Practice address
- 112 Three West Pkwy
Villa Rica, GA 30180-4778 - Phone
- (770) 459-6533
- Fax
- (770) 462-1260
- NPI assigned
- Jun 21, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| PCET003613 | GA | MD | Speech-Language Pathologist |
| SLP012557 | GA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapy Excellence | Speech-Language Pathologist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP012557 | GA | Yes |
Addresses
Primary practice location
112 Three West Pkwy
Villa Rica, GA 30180-4778
Mailing address
112 Three West Pkwy
Villa Rica, GA 30180-4778
Phone (770) 459-6533
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003285781A | Medicaid | GA |
Other names
- Johanna Wagner
Other providers in Villa Rica, GA
- Chelsea Grant Bode
- William Todd Boleman
- Bonnie Kristine Boles
- Yolanda Therese Booker
- James Larry Boss
- Carter Dale Brannon
- Brian a Bain DDS III PC
- Ann Hamilton Brown
- Benita N Brown
- Jacqueline Brown
All providers in Villa Rica, GA · Speech-Language Pathologist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 2026. 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.