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General NPI Number Information
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NPI Number | 1689582124
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Entity Type | Individual
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Provider Name | FUEY CLARIE PHAN
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Gender | Female
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Dates
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Enumeration Date | 08/27/2026
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Last Update Date | 08/27/2026
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Provider Practice Location Address
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Address Line | 4620 VALLECITO ST
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City | SHASTA LAKE
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State | CA
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Zip | 96019-9348
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Country | US
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Telephone | 530-275-7020
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Fax | 530-275-7025
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Provider Business Mailing Address
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Address Line | 4411 MOUNTAIN LAKES BLVD
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City | REDDING
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State | CA
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Zip | 96003-1446
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Country | US
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Telephone | 530-245-7900
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Fax | 530-245-7920
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 19916
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License Number State | CA
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