Provider Demographics
NPI:1508496944
Name:MOHAN, PATRICIA JOHANNA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JOHANNA
Last Name:MOHAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:PATTI
Other - Middle Name:JOHANNA
Other - Last Name:MOHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP, MS
Mailing Address - Street 1:3685 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-1023
Mailing Address - Country:US
Mailing Address - Phone:714-585-9159
Mailing Address - Fax:
Practice Address - Street 1:3685 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-1023
Practice Address - Country:US
Practice Address - Phone:714-585-9159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22398235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist