Provider Demographics
NPI:1619905544
Name:WANG, JUAN (AUD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:109 E FERN AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-9430
Mailing Address - Country:US
Mailing Address - Phone:956-661-8200
Mailing Address - Fax:956-661-8205
Practice Address - Street 1:301 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4649
Practice Address - Country:US
Practice Address - Phone:956-661-8200
Practice Address - Fax:956-661-8205
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51075231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX528468OtherBC/BS
TX528268Medicare ID - Type UnspecifiedPROVIDER NUMBER