Provider Demographics
NPI:1043469315
Name:NAMBOODIRI, MAYA HARIKRISHNAN (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:MAYA
Middle Name:HARIKRISHNAN
Last Name:NAMBOODIRI
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W FRONTAGE RD # SPAJ
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2300
Mailing Address - Country:US
Mailing Address - Phone:956-787-6777
Mailing Address - Fax:956-787-6778
Practice Address - Street 1:1011 W FRONTAGE RD # SPAJ
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2300
Practice Address - Country:US
Practice Address - Phone:956-787-6777
Practice Address - Fax:956-787-6778
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17488235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist