Provider Demographics
NPI:1205496585
Name:KHATRI, NAILA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:NAILA
Middle Name:
Last Name:KHATRI
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 REDPINE LOOP
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3072
Mailing Address - Country:US
Mailing Address - Phone:732-986-2437
Mailing Address - Fax:
Practice Address - Street 1:400 BELCHASE DR STE 406
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-9760
Practice Address - Country:US
Practice Address - Phone:732-446-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00988800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist