Active NPI
Lisa Phung, SLP
- Speech-Language Pathologist
- Wallingford, CT
National Provider Identifier
1740634799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 4021
- Practice address
- 300 Church St
Unit 102
Wallingford, CT 06492-2253 - Phone
- (203) 410-0974
- NPI assigned
- Apr 15, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 4021 | CT | Primary |
Addresses
Primary practice location
300 Church St
Unit 102
Wallingford, CT 06492-2253
Mailing address
300 Church St
Unit 102
Wallingford, CT 06492-2253
Phone (203) 410-0974
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 462195986 | Other | CT | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4021 | CT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1460678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460678400000",
"number": "1740634799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 CHURCH ST",
"address_2": "UNIT 102",
"city": "WALLINGFORD",
"state": "CT",
"postal_code": "064922253",
"telephone_number": "203-410-0974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 CHURCH ST",
"address_2": "UNIT 102",
"city": "WALLINGFORD",
"state": "CT",
"postal_code": "064922253",
"telephone_number": "203-410-0974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHUNG",
"first_name": "LISA",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-15",
"last_updated": "2016-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CT",
"license": "4021",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "462195986",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wallingford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.