Provider Demographics
NPI:1083186787
Name:JAYARAM, ANJANA (SLP)
Entity Type:Individual
Prefix:MS
First Name:ANJANA
Middle Name:
Last Name:JAYARAM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 CANDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-4651
Mailing Address - Country:US
Mailing Address - Phone:425-985-8682
Mailing Address - Fax:
Practice Address - Street 1:831 CANDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-4651
Practice Address - Country:US
Practice Address - Phone:425-985-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP23784235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist