Doctor Name: | KETAKI VAIDYA |
NPI Number: | 1609130442 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 19757 |
Business Practice Address: | 21966 Dolores St Castro Valley, CA - 945466900 |
Business Phone Number: | 5107332102 |
Business Fax Number: | |
Mailing Address: | 1401 Red Hawk Cir Apt I202, FREMONT |
State: | CA |
Postal Code: | 945384765 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/26/2012 |
NPI Last Update Date: | 06/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 19757 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
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 |