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NPI Code Detail

MEDICARE: MS. CHAN THAI LUONG CCC-SLP

MEDICARE:  MS. CHAN THAI LUONG  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
1235Z00000XSpeech-Language Pathologist41075804TX

General Provider Information

NPI Number : 1417497884
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHAN THAI LUONG CCC-SLP
Provider Business Mailing Address
First Line : 4413 KOEHLER ST UNIT E
Second Line :
City : HOUSTON
State : TX
Zip : 77007-3592
Country : US
Telephone Number : 316-519-1795
Fax Number :
Provider Business Practice Location Address
First Line : 4413 KOEHLER ST UNIT E
Second Line :
City : HOUSTON
State : TX
Zip : 77007-3592
Country : US
Telephone Number : 316-519-1795
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2017
Last Update Date : 04/18/2023

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Directions to “ MS. CHAN THAI LUONG CCC-SLP” Practice Location

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