Provider Demographics
NPI:1710550751
Name:NGUYEN, BAO-NGOC L (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BAO-NGOC
Middle Name:L
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:BAO
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2205 SUNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-3969
Mailing Address - Country:US
Mailing Address - Phone:409-354-6767
Mailing Address - Fax:
Practice Address - Street 1:665 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94592-1177
Practice Address - Country:US
Practice Address - Phone:707-556-8921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist