Provider Demographics
NPI:1326491507
Name:KHAWAJA, SASHA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:KHAWAJA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 E YOUNTVILLE DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-3860
Mailing Address - Country:US
Mailing Address - Phone:909-239-2815
Mailing Address - Fax:
Practice Address - Street 1:933 E DEODAR ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-1309
Practice Address - Country:US
Practice Address - Phone:909-985-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2023-10-19
Deactivation Date:2019-03-28
Deactivation Code:
Reactivation Date:2019-04-10
Provider Licenses
StateLicense IDTaxonomies
CA36069235Z00000X
2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist