Doctor Name: | MR. KATHIRESAN RAJENDRAN |
NPI Number: | 1033478219 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S,CCC-SLP |
License Number: | SA10272 |
Business Practice Address: | 12627 San Jose Blvd Ste. 506 Jacksonville, FL - 322232662 |
Business Phone Number: | 3013000382 |
Business Fax Number: | 8777363470 |
Mailing Address: | 12627 San Jose Blvd, Ste. 506 JACKSONVILLE |
State: | FL |
Postal Code: | 322232662 |
Phone Number: | 3013000382 |
Fax Number: | 8777363470 |
NPI Enumeration Date: | 05/09/2012 |
NPI Last Update Date: | 05/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA10272 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |