Provider Demographics
NPI:1104212281
Name:RAGHAVAN, RAKSHITA (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:RAKSHITA
Middle Name:
Last Name:RAGHAVAN
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 1:1120 DUNAWAY ST
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3839
Mailing Address - Country:US
Mailing Address - Phone:937-866-9089
Mailing Address - Fax:
Practice Address - Street 1:1120 DUNAWAY ST
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3839
Practice Address - Country:US
Practice Address - Phone:937-866-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 8285235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist