Provider Demographics
NPI:1457654618
Name:LATHAM, ASHA (CF-SLP)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:LATHAM
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 RALPH AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-4999
Mailing Address - Country:US
Mailing Address - Phone:347-371-9465
Mailing Address - Fax:
Practice Address - Street 1:513 RALPH AVE
Practice Address - Street 2:FL 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-4999
Practice Address - Country:US
Practice Address - Phone:347-371-9465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist