Provider Demographics
NPI:1144410515
Name:HOANG, THAO PHUONG (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:PHUONG
Last Name:HOANG
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 N KYLE WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-1927
Mailing Address - Country:US
Mailing Address - Phone:904-631-0885
Mailing Address - Fax:
Practice Address - Street 1:1347 N KYLE WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-1927
Practice Address - Country:US
Practice Address - Phone:904-631-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist