MEDICARE: THAO PHUONG HOANG M.A., CCC/SLP

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	235Z00000X	Speech-Language Pathologist	SA7337	FL

General Provider Information

NPI Number	:	1144410515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAO PHUONG HOANG M.A., CCC/SLP

Provider Business Mailing Address
First Line	:	1347 N KYLE WAY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32259-1927
Country	:	US
Telephone Number	:	904-631-0885
Fax Number	:

Provider Business Practice Location Address
First Line	:	1347 N KYLE WAY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32259-1927
Country	:	US
Telephone Number	:	904-631-0885
Fax Number	:

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

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	07/31/2007

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