Individual provider Active NPI

Cassandra Johanson

  • Speech-Language Pathologist
  • Phoenix, AZ
National Provider Identifier
1487790218
Registry record updated Sep 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLPL2188 Issued in AZ
Practice address
20402 N, 15TH Ave
Phoenix, AZ 85027
Phone
(623) 445-5000
NPI assigned
Jan 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2016

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 SLPL2188 AZ Primary

Addresses

Primary practice location

20402 N, 15TH Ave
Phoenix, AZ 85027

Mailing address

4417 E Muriel Dr
Phoenix, AZ 85032-9257
Phone (602) 561-8079

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

LicenseStateTypeSpecialty
SLPL2188AZMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472774400000",
    "number": "1487790218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4417 E MURIEL DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850329257",
            "telephone_number": "602-561-8079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20402 N, 15TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85027",
            "telephone_number": "623-445-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSON",
        "first_name": "CASSANDRA",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2016-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "SLPL2188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; 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.