Provider Demographics
NPI:1508464058
Name:NAKANISHI, LAUREL
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:
Last Name:NAKANISHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 DANUBE DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-2813
Mailing Address - Country:US
Mailing Address - Phone:831-662-9255
Mailing Address - Fax:
Practice Address - Street 1:6920 SANTA TERESA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1344
Practice Address - Country:US
Practice Address - Phone:408-605-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP6622235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist