Most Relevant Information
Provider Data
| NPI Number: | 1003335654 |
| Provider Name: | PORNPHUN SLAYDEN |
| Entity Type: | Individual |
| Taxonomy Code: | 106H00000X |
| Specialty: | Marriage & Family Therapist |
| License Number: | 123258 |
Most Important Dates
| Enumeration Date: | 09/14/2017 |
| Last Updated: | 09/07/2022 |
Provider Practice Location
20 WINOOSKI FALLS WAY STE 400
WINOOSKI
VT
054042239
Practice Location Phone/Fax
| Phone: | 8028570400 |
| Fax: |
Provider Mailing Location
15305 RAYEN ST
NORTH HILLS
CA
913435117
Provider Mailing Phone/Fax
| Phone: | 8188923423 |
| Fax: | 8188934509 |