Provider Demographics
NPI:1508102617
Name:KOONT, RAJVEENA KAUR (MS SLP)
Entity Type:Individual
Prefix:
First Name:RAJVEENA
Middle Name:KAUR
Last Name:KOONT
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:RAJVEENA
Other - Middle Name:
Other - Last Name:MANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SLP
Mailing Address - Street 1:4129 ARAGON WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-8007
Mailing Address - Country:US
Mailing Address - Phone:916-380-7830
Mailing Address - Fax:
Practice Address - Street 1:4129 ARAGON WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-8007
Practice Address - Country:US
Practice Address - Phone:916-380-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6762235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist