Provider Demographics
NPI:1164745188
Name:ADVANI, ASHA ARJUN (MA-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ASHA
Middle Name:ARJUN
Last Name:ADVANI
Suffix:
Gender:F
Credentials:MA-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 CRABAPPLE RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4020
Mailing Address - Country:US
Mailing Address - Phone:770-573-1715
Mailing Address - Fax:770-573-0887
Practice Address - Street 1:12200 CRABAPPLE RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-4020
Practice Address - Country:US
Practice Address - Phone:770-573-1715
Practice Address - Fax:770-573-0887
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist