Provider Demographics
NPI:1992116339
Name:WITBECK, THAO HANH (MS, CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:THAO
Middle Name:HANH
Last Name:WITBECK
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:THAO
Other - Middle Name:HANH
Other - Last Name:DO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP/L
Mailing Address - Street 1:933 N OTTILLIA ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3738
Mailing Address - Country:US
Mailing Address - Phone:847-322-7465
Mailing Address - Fax:
Practice Address - Street 1:2251 E PARIS AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2431
Practice Address - Country:US
Practice Address - Phone:616-447-7799
Practice Address - Fax:616-724-4117
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist