Pornphun Slayden

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

12789279-3902 Issued in UT

Practice address

20 Winooski Falls Way Ste 400
Winooski, VT 05404-2239

Phone

(802) 857-0400

NPI assigned

Sep 14, 2017

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 7, 2022.

{
    "created_epoch": "1505347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1003335654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15305 RAYEN ST",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913435117",
            "telephone_number": "818-892-3423",
            "fax_number": "818-893-4509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 WINOOSKI FALLS WAY STE 400",
            "city": "WINOOSKI",
            "state": "VT",
            "postal_code": "054042239",
            "telephone_number": "802-857-0400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3580 Wilshire Blvd Ste 800",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900102505",
            "country_code": "US",
            "telephone_number": "213-637-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3580 Wilshire Blvd Ste 800",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900102505",
            "country_code": "US",
            "telephone_number": "213-637-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15305 Rayen St",
            "address_purpose": "LOCATION",
            "city": "North Hills",
            "state": "CA",
            "postal_code": "91343",
            "country_code": "US",
            "telephone_number": "818-892-3423",
            "fax_number": "818-893-4509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SLAYDEN",
        "first_name": "PORNPHUN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-14",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "123258",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "UT",
            "license": "12789279-3902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pjitjumnonk@pennylane.org",
            "affiliation": "N",
            "address_1": "15305 Rayen St",
            "city": "North Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "91343",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• All providers in Winooski, VT
• Marriage & Family Therapist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.