Provider Demographics
NPI:1588020531
Name:PALAFOX, PHUONG (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:
Last Name:PALAFOX
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 1:12129 BLACK ANGUS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6708
Mailing Address - Country:US
Mailing Address - Phone:512-608-9695
Mailing Address - Fax:
Practice Address - Street 1:1505 W KOENIG LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1415
Practice Address - Country:US
Practice Address - Phone:512-480-9573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101859235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist