Nichole Johnson, M.A., CCC/SLP-L

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

015-SLP Issued in SD

Practice address

610 Lincoln St
Centerville, SD 57014-2040

Phone

(605) 563-2291

NPI assigned

Jul 12, 2016

Last updated

Jul 12, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

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.

• Centerville School District 60-01

  • Local Education Agency (LEA)
  • Centerville, SD
  • NPI 1407181001
  NPD (past)

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

{
    "created_epoch": "1468281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468281600000",
    "number": "1790137834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30437 UNIVERSITY RD",
            "city": "CENTERVILLE",
            "state": "SD",
            "postal_code": "570146536",
            "telephone_number": "605-563-2291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 LINCOLN ST",
            "city": "CENTERVILLE",
            "state": "SD",
            "postal_code": "570142040",
            "telephone_number": "605-563-2291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NICHOLE",
        "credential": "M.A., CCC/SLP-L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-12",
        "last_updated": "2016-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SD",
            "license": "015-SLP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Centerville Development Corporation (Centerville Care and Rehab Center)
• Centerville School District 60-01
• Justin Delzer, D.C.
• Keri Anne Hansen, MS, OTR/L
• Lavonne Isaak
• Michelle Lea Nelson, RPT
• Pioneer Memorial Hospital & Health Services (Centerville Medical Clinic)
• Pioneer Memorial Hospital &Health Services (Centerville Medical Clinic)
• Pioneer Memorial Hospital and Health Services (Centerville Community Pharmacy)
• Kalli Price

• Speech-Language Pathologist in Centerville, SD
• Providers in Centerville, SD by specialty
• Speech-Language Pathologist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.