Healthcare Provider Details

I. General information

NPI: 1902544174
Provider Name (Legal Business Name): HOANG-MY TRAN NGUYEN-SLAUTER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/04/2024
Certification Date: 05/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N CENTRAL AVE FL 18
PHOENIX AZ
85004-2322
US

IV. Provider business mailing address

2 N CENTRAL AVE FL 18
PHOENIX AZ
85004-2322
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 614-941-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2102584
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: