Individual provider Active NPI

Crystal G Johnson, SLP

  • Speech-Language Pathologist
  • Roanoke, VA
National Provider Identifier
1942404595
Registry record updated Jan 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2202005267 Issued in VA
Practice address
1127 Persinger Rd SW
Roanoke, VA 24015-3829
Phone
(540) 343-1691
NPI assigned
Jun 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2026

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 2202005267 VA Primary

Addresses

Primary practice location

1127 Persinger Rd SW
Roanoke, VA 24015-3829

Mailing address

1127 Persinger Rd SW
Roanoke, VA 24015-3829
Phone (540) 343-1691

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200306002281 DC Practitioner - Qualified Speech Language Pathologist 1850621277 Reassigns benefits to 1 organization
I20200529002781 VA Practitioner - Qualified Speech Language Pathologist 1850621277 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2202005267VAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Functional Pathways Preferred of Tennessee LLC Speech-Language Pathologist CurrentSince Feb 22, 2024 Accepting new patients

Locations

10133 Sherrill Blvd
Ste 200
Knoxville, TN 37932
Phone (865) 392-2847

1009 Old Country Club Rd NW
Roanoke, VA 24017
Phone (540) 344-6248

1410 N Augusta St
#A
Staunton, VA 24401

3317 Ocean Shore Ave
Virginia Beach, VA 23451
Phone (757) 232-3179

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769472000000",
    "number": "1942404595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1127 PERSINGER RD SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240153829",
            "telephone_number": "540-343-1691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 PERSINGER RD SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240153829",
            "telephone_number": "540-343-1691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CRYSTAL",
        "middle_name": "G",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-14",
        "last_updated": "2026-01-27",
        "certification_date": "2026-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202005267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2026; 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.