Provider Demographics
NPI:1689358533
Name:JOHNSON, CARLI PRUDHOMME (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARLI
Middle Name:PRUDHOMME
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:OLLA
Mailing Address - State:LA
Mailing Address - Zip Code:71465-9762
Mailing Address - Country:US
Mailing Address - Phone:318-312-0900
Mailing Address - Fax:
Practice Address - Street 1:1921 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:OLLA
Practice Address - State:LA
Practice Address - Zip Code:71465-9762
Practice Address - Country:US
Practice Address - Phone:318-312-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist