Tracie Lynn Johnson, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Marion, MS
NPI 1992960306 · NPPES record last updated Jul 24, 2008
Key facts
- NPI
- 1992960306
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- S3156 (MS)
- Practice address
- 6304 Koosa Dr
Marion, MS 39342-9458 - Phone
- (205) 317-7757
- NPI assigned
- Jul 24, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S3156 | MS | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | S3156 | MS | Yes |
Addresses
Primary practice location
6304 Koosa Dr
Marion, MS 39342-9458
Mailing address
6304 Koosa Dr
Marion, MS 39342-9458
Phone (205) 317-7757
Other providers in Marion, MS
- Wiliam Samuel Gardner
- Guardian Angel Healthcare, Inc.
- Jill Hickman
- Lauren Reece Hill
- Inner Images Consulting LLC
- Kemper, Cah, Inc.
- Jennifer P Lafferty
- Marion Discount Drugs
- Marion Health and Rehab, LLC
- Elizabeth McKenzie
All providers in Marion, MS · Speech-Language Pathologist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.