Provider Demographics
NPI:1467926519
Name:NG, YU FANG (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:YU FANG
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:FYN
Other - Middle Name:
Other - Last Name:NG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:3560 MALVERN ST APT 206
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-7213
Mailing Address - Country:US
Mailing Address - Phone:512-348-0556
Mailing Address - Fax:
Practice Address - Street 1:5980 RADIO STATION RD
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-3337
Practice Address - Country:US
Practice Address - Phone:301-932-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist