Individual provider Active NPI

Julie M Johnson, MS CCC SLP

  • Speech-Language Pathologist
  • Natchez, MS
National Provider Identifier
1669521837
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
S2812 Issued in MS
Practice address
123 Jefferson Davis Blvd
Natchez, MS 39120-5103
Phone
(601) 445-0005
Fax
(601) 445-0370
NPI assigned
Jan 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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 S2812 MS Primary

Addresses

Primary practice location

123 Jefferson Davis Blvd
Natchez, MS 39120-5103

Mailing address

123 Jefferson Davis Blvd
Natchez, MS 39120-5103
Phone (601) 445-0005

Other identifiers 2

IdentifierTypeStateIssuer
1431281MedicaidLA
07482327MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151221001958 MS Practitioner - Qualified Speech Language Pathologist 8527369313 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Natchez Rehab & Sports Specialists CurrentSince Nov 16, 2015 Accepting new patients
Key Medical Supply,LLC Past Accepting new patients
Key Rehab Associates, Inc. Speech-Language Pathologist Past Accepting new patients

Locations

135 Highway 61 S
#2
Natchez, MS 39120
Phone (601) 446-8764

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1669521837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 JEFFERSON DAVIS BLVD",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391205103",
            "telephone_number": "601-445-0005",
            "fax_number": "601-445-0370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 JEFFERSON DAVIS BLVD",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391205103",
            "telephone_number": "601-445-0005",
            "fax_number": "601-445-0370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JULIE",
        "middle_name": "M",
        "credential": "MS CCC SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-09",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S2812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1431281",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07482327",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Natchez, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.