Kelley Opiola Johnson, CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP15872 Issued in CA

Practice address

824 Caminito del Mar
Carlsbad, CA 92011-2401

Phone

(760) 814-3143

NPI assigned

Jul 2, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kelley Klismith Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1435795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435795200000",
    "number": "1316320757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 CAMINITO DEL MAR",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920112401",
            "telephone_number": "760-814-3143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 CAMINITO DEL MAR",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920112401",
            "telephone_number": "760-814-3143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OPIOLA JOHNSON",
        "first_name": "KELLEY",
        "credential": "CCC/SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-02",
        "last_updated": "2015-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP15872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLEY",
            "last_name": "KLISMITH",
            "credential": "CCC/SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Carlsbad, CA
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2015; 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.