Individual
LISA PHUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
300 CHURCH ST, UNIT 102, WALLINGFORD, CT 06492-2253
(203) 410-0974
Mailing address
300 CHURCH ST, UNIT 102, WALLINGFORD, CT 06492-2253
(203) 410-0974
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4021
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
462195986
TAX ID
CT
Enumeration date
04/15/2016
Last updated
04/15/2016
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