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NPI Code Detail

MEDICARE: MRS. THAO HANH WITBECK MS, CCC-SLP/L

MEDICARE: MRS. THAO HANH WITBECK MS, CCC-SLP/L
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 Pathologist

General Provider Information

NPI Number : 1992116339
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. THAO HANH WITBECK MS, CCC-SLP/L
Provider Business Mailing Address
First Line : 933 N OTTILLIA ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49507-3738
Country : US
Telephone Number : 847-322-7465
Fax Number :
Provider Business Practice Location Address
First Line : 2251 E PARIS AVE SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-2431
Country : US
Telephone Number : 616-447-7799
Fax Number : 616-724-4117
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2014
Last Update Date : 04/06/2022

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