Individual
CASEY VONGPHRACHANH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
55 AUBURN AVE, SUITE A, SIERRA MADRE, CA 91024-1847
(626) 355-1729
Mailing address
2402 ARLINE ST, WEST COVINA, CA 91792-2114
(510) 666-7733
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9529
CA
Other
Enumeration date
11/19/2014
Last updated
11/19/2014
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