Basic Information
| Provider Information | |||||||||
| NPI: | 1609900729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, CCC, SLP-L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 192 S SMITH ST | ||||||||
| Address2: | |||||||||
| City: | COCHRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163148622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144252224 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 12TH ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163231217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144373071 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL000922L | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | SL000922L | 01 | PA | STATE LICENSE | OTHER |