Provider Demographics
NPI:1972817401
Name:TRUONG, CAM VAN THI (MS SLP)
Entity Type:Individual
Prefix:MISS
First Name:CAM VAN
Middle Name:THI
Last Name:TRUONG
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7945 SILVERLEAF ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-3624
Mailing Address - Country:US
Mailing Address - Phone:409-466-1776
Mailing Address - Fax:
Practice Address - Street 1:4225 LAKE ARTHUR DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-6490
Practice Address - Country:US
Practice Address - Phone:409-363-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105995235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist