Individual provider Active NPI

Caroline Elizabeth Johnson

  • Speech-Language Pathologist
  • Dallas, TX
National Provider Identifier
1902380157
Registry record updated Sep 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
115118 Issued in TX
Practice address
419 W Pembroke Ave
Dallas, TX 75208-6535
Phone
(512) 297-5955
NPI assigned
Sep 23, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 23, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X 115118 TX Primary

Addresses

Primary practice location

419 W Pembroke Ave
Dallas, TX 75208-6535

Mailing address

4717 Twin Valley Dr
Austin, TX 78731-3536
Phone (512) 297-5955

Other practice location 1

326 E 12th St
Dallas, TX 75203-2606
Phone (512) 297-5955

Other practice location 2

3020 N Westmoreland Rd
Dallas, TX 75212-3647
Phone (512) 297-5955

Other practice location 3

2200 E Ledbetter Dr
Dallas, TX 75216-7408
Phone (512) 297-5955

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

LicenseStateTypeSpecialty
115118TXMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1537660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537660800000",
    "number": "1902380157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4717 TWIN VALLEY DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787313536",
            "telephone_number": "512-297-5955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 W PEMBROKE AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752086535",
            "telephone_number": "512-297-5955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "326 E 12th St",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752032606",
            "country_code": "US",
            "telephone_number": "512-297-5955",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3020 N Westmoreland Rd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752123647",
            "country_code": "US",
            "telephone_number": "512-297-5955",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2200 E Ledbetter Dr",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752167408",
            "country_code": "US",
            "telephone_number": "512-297-5955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CAROLINE",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-23",
        "last_updated": "2018-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "115118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2018; 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.