MEDICARE: NHUNGLESLEY KIM LE SLPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	10400	AZ

General Provider Information

NPI Number	:	1396416764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NHUNGLESLEY KIM LE SLPA

Provider Business Mailing Address
First Line	:	6610 N 93RD AVE APT 1097
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85305-3187
Country	:	US
Telephone Number	:	707-696-5219
Fax Number	:

Provider Business Practice Location Address
First Line	:	6602 W OSBORN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85033-4533
Country	:	US
Telephone Number	:	623-691-5600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	09/24/2021

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Directions to “ NHUNGLESLEY KIM LE SLPA” Practice Location

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