Individual provider Active NPI

Lanae Marie Johnson, M.S. CCC-SLP

  • Speech-Language Pathologist
  • Raleigh, NC
National Provider Identifier
1497133904
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
11450 Issued in NC
Practice address
211 E Six Forks Rd Ste 107
Raleigh, NC 27609-7743
Phone
(919) 619-2355
Fax
(877) 499-6803
NPI assigned
May 16, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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 11450 NC Primary

Addresses

Primary practice location

211 E Six Forks Rd Ste 107
Raleigh, NC 27609-7743

Mailing address

211 E Six Forks Rd Ste 107
Raleigh, NC 27609-7743
Phone (919) 619-2355

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
11450NCMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Wright Pediatric Therapy Speech-Language Pathologist Current Accepting new patients

Locations

211 E Six Forks Rd
Ste 221
Raleigh, NC 27609
Phone (336) 698-5904

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1431734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737676800000",
    "number": "1497133904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 E SIX FORKS RD STE 107",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097743",
            "telephone_number": "919-619-2355",
            "fax_number": "877-499-6803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 E SIX FORKS RD STE 107",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097743",
            "telephone_number": "919-619-2355",
            "fax_number": "877-499-6803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "LANAE",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-16",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "11450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; 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.