Provider Demographics
NPI:1093196602
Name:CHAN, WAI KING (MS SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:WAI KING
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:MS SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PECAN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5544
Mailing Address - Country:US
Mailing Address - Phone:845-553-3494
Mailing Address - Fax:
Practice Address - Street 1:22 PECAN VALLEY DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5544
Practice Address - Country:US
Practice Address - Phone:845-553-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist