Active NPI
Jacqueline J Johnson, CCC-SLP
- Speech-Language Pathologist
- Luverne, MN
National Provider Identifier
1629326913
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 12008996
- Practice address
- 709 N Kniss Ave
Luverne, MN 56156-1229 - Phone
- (507) 283-4497
- NPI assigned
- Aug 17, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 12008996 | MN | Primary |
Addresses
Primary practice location
709 N Kniss Ave
Luverne, MN 56156-1229
Mailing address
812 Blue Water Cir
Luverne, MN 56156-1302
Phone (605) 228-0142
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
| License | State | Type | Specialty |
|---|---|---|---|
| 12008996 | MN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776902400000",
"number": "1629326913",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "812 BLUE WATER CIR",
"city": "LUVERNE",
"state": "MN",
"postal_code": "561561302",
"telephone_number": "605-228-0142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "709 N KNISS AVE",
"city": "LUVERNE",
"state": "MN",
"postal_code": "561561229",
"telephone_number": "507-283-4497"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JACQUELINE",
"middle_name": "J",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-17",
"last_updated": "2026-04-23",
"certification_date": "2026-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "12008996",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Luverne, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.