Provider Demographics
NPI:1730734310
Name:TAN, AUDREY SIU FEN
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:SIU FEN
Last Name:TAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SIU FEN AUDREY
Other - Middle Name:
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12 STONEHOLM ST APT 420
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-2914
Mailing Address - Country:US
Mailing Address - Phone:650-842-0852
Mailing Address - Fax:
Practice Address - Street 1:145 SOUTH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-2826
Practice Address - Country:US
Practice Address - Phone:617-521-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist