Tracie Lynn Johnson, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

S3156 Issued in MS

Practice address

6304 Koosa Dr
Marion, MS 39342-9458

Phone

(205) 317-7757

NPI assigned

Jul 24, 2008

Last updated

Jul 24, 2008By 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

State licenses

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

{
    "created_epoch": "1216857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216857600000",
    "number": "1992960306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6304 KOOSA DR",
            "city": "MARION",
            "state": "MS",
            "postal_code": "393429458",
            "telephone_number": "205-317-7757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6304 KOOSA DR",
            "city": "MARION",
            "state": "MS",
            "postal_code": "393429458",
            "telephone_number": "205-317-7757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TRACIE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-24",
        "last_updated": "2008-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S3156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wiliam Samuel Gardner, ATC
• Guardian Angel Healthcare, Inc.
• Jill Hickman
• Lauren Reece Hill, MS, RDN, LDN
• Inner Images Consulting LLC
• Kemper, Cah, Inc. (Ochsner Health Center-Marion)
• Jennifer P Lafferty, FNP
• Marion Discount Drugs (Marion Discount Drugs LLC)
• Marion Health and Rehab, LLC
• Elizabeth McKenzie

• Speech-Language Pathologist in Marion, MS
• Providers in Marion, MS by specialty
• Speech-Language Pathologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2008; 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.