Provider Demographics
NPI:1033207188
Name:NISHIKAWA, LYNN KEIKO (SPL)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:KEIKO
Last Name:NISHIKAWA
Suffix:
Gender:F
Credentials:SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6177 RIVER CREST DR STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0728
Mailing Address - Country:US
Mailing Address - Phone:951-653-4480
Mailing Address - Fax:951-653-5051
Practice Address - Street 1:6177 RIVER CREST DR STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0728
Practice Address - Country:US
Practice Address - Phone:951-653-4480
Practice Address - Fax:951-653-5051
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPL 4022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17185ZMedicare PIN