Provider Demographics
NPI:1689698458
Name:JOHNSTON, NANCY C (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:JOHNSTON
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 1:455 W WARREN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4002
Mailing Address - Country:US
Mailing Address - Phone:407-260-0551
Mailing Address - Fax:407-265-9590
Practice Address - Street 1:455 W WARREN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4002
Practice Address - Country:US
Practice Address - Phone:407-260-0551
Practice Address - Fax:407-265-9590
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5296235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885268500Medicaid