Provider Demographics
NPI:1114375201
Name:LAKHTAKIA, NATALYA SHEETAL (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NATALYA
Middle Name:SHEETAL
Last Name:LAKHTAKIA
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 1:41 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-1942
Mailing Address - Country:US
Mailing Address - Phone:801-828-7173
Mailing Address - Fax:
Practice Address - Street 1:220 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-1590
Practice Address - Country:US
Practice Address - Phone:801-828-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-30
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY024637-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist