Provider Demographics
NPI:1093343022
Name:THAMBAN, RAJI SUSAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RAJI
Middle Name:SUSAN
Last Name:THAMBAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:RAJI
Other - Middle Name:SUSAN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:23223 GOSLING RD APT 5107
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-5464
Mailing Address - Country:US
Mailing Address - Phone:832-651-0924
Mailing Address - Fax:
Practice Address - Street 1:3205 W DAVIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2039
Practice Address - Country:US
Practice Address - Phone:936-709-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist