Provider Demographics
NPI:1922731371
Name:STANTON, CHAU NGOC BANH
Entity Type:Individual
Prefix:
First Name:CHAU
Middle Name:NGOC BANH
Last Name:STANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15080 OAKCREST CT
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-4650
Mailing Address - Country:US
Mailing Address - Phone:952-297-7654
Mailing Address - Fax:
Practice Address - Street 1:15080 OAKCREST CT
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-4650
Practice Address - Country:US
Practice Address - Phone:952-297-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00000436225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist