MEDICARE: CHIARA PHAN 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	110356	TX

General Provider Information

NPI Number	:	1821447715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIARA PHAN SLP

Provider Business Mailing Address
First Line	:	7010 NW 100 DR # A104
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-2052
Country	:	US
Telephone Number	:	713-993-7554
Fax Number	:	866-849-5747

Provider Business Practice Location Address
First Line	:	7010 NW 100 DR # A104
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-2052
Country	:	US
Telephone Number	:	713-993-7554
Fax Number	:	866-849-5747

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

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	06/10/2016

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Directions to “ CHIARA PHAN SLP” Practice Location

Language	Start Address	Practice Location

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