Provider Demographics
NPI:1144788027
Name:RAJKOTIA, RIMA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RIMA
Middle Name:M
Last Name:RAJKOTIA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5316 APPLESEED WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-3518
Mailing Address - Country:US
Mailing Address - Phone:224-381-8017
Mailing Address - Fax:
Practice Address - Street 1:801 W ANN ARBOR TRL STE 200
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1694
Practice Address - Country:US
Practice Address - Phone:224-381-8017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-09
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006992A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22006992AOtherSPEECH PATHOLOGIST IN LICENSE NUMBER