Provider Demographics
NPI:1669604906
Name:PHAM, THAO TRINH (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:THAO
Middle Name:TRINH
Last Name:PHAM
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:377 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5055
Mailing Address - Country:US
Mailing Address - Phone:714-528-4405
Mailing Address - Fax:714-528-8162
Practice Address - Street 1:377 E CHAPMAN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5055
Practice Address - Country:US
Practice Address - Phone:714-528-4405
Practice Address - Fax:714-528-8162
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CASP 11258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist