Provider Demographics
NPI:1609319268
Name:MUNSEY, PHILIP ERLE (SLP)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:ERLE
Last Name:MUNSEY
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10419 DONNER AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-3739
Mailing Address - Country:US
Mailing Address - Phone:209-481-3164
Mailing Address - Fax:
Practice Address - Street 1:10419 DONNER AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-3739
Practice Address - Country:US
Practice Address - Phone:209-481-3164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9429235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP9429OtherCALIFORNIA STATE LISENCE NUMBER