Provider Demographics
NPI:1619297157
Name:TAM, JANETTE THANH (MA, CCC- SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANETTE
Middle Name:THANH
Last Name:TAM
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 1:1064 WATERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-8152
Mailing Address - Country:US
Mailing Address - Phone:801-850-6712
Mailing Address - Fax:
Practice Address - Street 1:1064 WATERSIDE DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-8152
Practice Address - Country:US
Practice Address - Phone:801-850-6712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP12517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC1348076OtherDRIVER LICENSE