Provider Demographics
NPI:1386406395
Name:PHAM, CARINA (SLP- ASSISTANT)
Entity type:Individual
Prefix:
First Name:CARINA
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:SLP- ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 TERRE HAUTE DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-6841
Mailing Address - Country:US
Mailing Address - Phone:903-714-8334
Mailing Address - Fax:
Practice Address - Street 1:1402 TERRE HAUTE DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-6841
Practice Address - Country:US
Practice Address - Phone:903-714-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX436422355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant