Provider Demographics
NPI:1285824391
Name:RAJAN, USHA (PHD CCC)
Entity Type:Individual
Prefix:MRS
First Name:USHA
Middle Name:
Last Name:RAJAN
Suffix:
Gender:F
Credentials:PHD CCC
Other - Prefix:
Other - First Name:USHA
Other - Middle Name:
Other - Last Name:MENON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1612 ROYAL OAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906
Mailing Address - Country:US
Mailing Address - Phone:419-756-6956
Mailing Address - Fax:
Practice Address - Street 1:50 BLYMYER
Practice Address - Street 2:MANSFIELD MEMORIAL HOMES
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907
Practice Address - Country:US
Practice Address - Phone:419-774-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP5807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist