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NPI Code Detail

MEDICARE: JING FAN SLP

MEDICARE: JING FAN 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 Pathologist101465TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18T3769OTHERTXBCBS

General Provider Information

NPI Number : 1811026677
Entity Type Code : Individual
Provider Name (Legal Business Name) : JING FAN SLP
Provider Business Mailing Address
First Line : 1121 E 7TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78702-3220
Country : US
Telephone Number : 512-334-4411
Fax Number : 512-334-4465
Provider Business Practice Location Address
First Line : 1121 E 7TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78702-3220
Country : US
Telephone Number : 512-334-4411
Fax Number : 512-334-4465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 07/08/2007

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Directions to “ JING FAN SLP” Practice Location

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