Provider Demographics
NPI:1194031187
Name:PHUONG, SIU TIAN (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:SIU
Middle Name:TIAN
Last Name:PHUONG
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16020 W SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2824
Mailing Address - Country:US
Mailing Address - Phone:623-451-2902
Mailing Address - Fax:623-925-8088
Practice Address - Street 1:16020 W SHERMAN ST.
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338
Practice Address - Country:US
Practice Address - Phone:623-451-2902
Practice Address - Fax:623-925-8088
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA65912355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant