Provider Demographics
NPI:1104187319
Name:TRAN, AIMY (SLP)
Entity Type:Individual
Prefix:MRS
First Name:AIMY
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 GOLD ST
Mailing Address - Street 2:APT 4A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3014
Mailing Address - Country:US
Mailing Address - Phone:718-435-2254
Mailing Address - Fax:
Practice Address - Street 1:1273 57TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4524
Practice Address - Country:US
Practice Address - Phone:718-435-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019753-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist