Marie A Johnson, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP0000004374 Issued in TN

Practice address

156 S Dossett Dr
Johnson City, TN 37614-1702

Phone

(423) 439-4355

Fax

(423) 439-4607

NPI assigned

Jul 27, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Medical Education Assistance Corporation

  dba ETSU Physicians and Associates

  • Internal Medicine Physician
  • Johnson City, TN
  • NPI 1235180480
  Medicare reassignment NPD
• East Tennessee State University

  dba Johnson City Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Johnson City, TN
  • NPI 1477660199
  NPD (past)
• Medical Education Assistance Corporation

  • Speech-Language Pathologist
  • Johnson City, TN
  • NPI 1164062659
  NPD (past)

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

{
    "created_epoch": "1343347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1841546850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "376840699",
            "telephone_number": "423-439-4355",
            "fax_number": "423-439-4607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 S DOSSETT DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376141702",
            "telephone_number": "423-439-4355",
            "fax_number": "423-439-4607"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Jason Witten Way",
            "address_purpose": "LOCATION",
            "city": "Elizabethton",
            "state": "TN",
            "postal_code": "376432970",
            "country_code": "US",
            "telephone_number": "423-439-4355",
            "fax_number": "423-543-0581",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2423 Susannah St",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376011719",
            "country_code": "US",
            "telephone_number": "423-915-9257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARIE",
        "middle_name": "A",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-27",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TN",
            "license": "SP0000004374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASHA",
            "identifier": "12146389",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1511884",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ST LICENSE",
            "identifier": "SP0000004374",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Peyton Johnson, MS, CCC-SLP
• Kristie L Johnson
• Krisztina Bucsi Johnson, CCC-A
• Leigh Johnson, M.D.
• Mackenzie Johnson
• Michael D Johnson, PA
• Michelle Eileen Johnson, M.S., R.D., LDN
• Phung Pham Johnson, DMD
• Roger Dale Johnson, FNP
• Ruth D Johnson, MSN

• Speech-Language Pathologist in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Speech-Language Pathologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; 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.