Provider Demographics
NPI:1821447715
Name:PHAN, CHIARA (SLP)
Entity Type:Individual
Prefix:
First Name:CHIARA
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CHIARA
Other - Middle Name:GAIL
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:7010 NW 100 DR # A104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-2052
Mailing Address - Country:US
Mailing Address - Phone:713-993-7554
Mailing Address - Fax:866-849-5747
Practice Address - Street 1:7010 NW 100 DR # A104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-2052
Practice Address - Country:US
Practice Address - Phone:713-993-7554
Practice Address - Fax:866-849-5747
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110356235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist