Individual provider Active NPI

Johanna Lynn Chang, MS, CCC-SLP

  • Speech-Language Pathologist
  • Huntington, NY
National Provider Identifier
1679249379
Registry record updated Aug 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
021243-01 Issued in NY
Practice address
775 Park Ave Ste 255
Huntington, NY 11743-7538
Phone
(516) 355-6001
NPI assigned
Aug 22, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 41YS00668500 NJ
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X 021243-01 NY Primary

Addresses

Primary practice location

775 Park Ave Ste 255
Huntington, NY 11743-7538

Mailing address

8 Roslyn Dr
Glen Head, NY 11545-1730
Phone (201) 982-0389

Other practice location 1

8 Roslyn Dr
Glen Head, NY 11545-1730
Phone (201) 982-0389

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)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
41YS00668500NJMDSpeech-Language Pathologist
021243-01NYMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1629590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629590400000",
    "number": "1679249379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 ROSLYN DR",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "115451730",
            "telephone_number": "201-982-0389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 PARK AVE STE 255",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117437538",
            "telephone_number": "516-355-6001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8 Roslyn Dr",
            "address_purpose": "LOCATION",
            "city": "Glen Head",
            "state": "NY",
            "postal_code": "115451730",
            "country_code": "US",
            "telephone_number": "201-982-0389",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHANG",
        "first_name": "JOHANNA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-22",
        "last_updated": "2021-08-22",
        "certification_date": "2021-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NJ",
            "license": "41YS00668500",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "021243-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2021; 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.