Provider Demographics
NPI:1376765313
Name:KHALSA, HARI HARI KAUR (MA/CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:HARI HARI
Middle Name:KAUR
Last Name:KHALSA
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:PO BOX 2011
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:NM
Mailing Address - Zip Code:87567-2011
Mailing Address - Country:US
Mailing Address - Phone:505-577-8705
Mailing Address - Fax:
Practice Address - Street 1:#8 ATHENAS WAY
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532
Practice Address - Country:US
Practice Address - Phone:505-753-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMJ7794Medicaid