Provider Demographics
NPI:1548474422
Name:JOHNSON, SUE BURNS (MA, CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:BURNS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 VIA CASTILLA
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2862
Mailing Address - Country:US
Mailing Address - Phone:310-613-2122
Mailing Address - Fax:
Practice Address - Street 1:PACIFIC HOSPITAL
Practice Address - Street 2:2776 PACIFIC AVE.
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:310-613-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist