Provider Demographics
NPI:1538660360
Name:MAKINO, NIKKI WU (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:WU
Last Name:MAKINO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:BIQIAN
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 E DEL MAR BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2714
Mailing Address - Country:US
Mailing Address - Phone:626-796-2016
Mailing Address - Fax:
Practice Address - Street 1:301 E DEL MAR BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2714
Practice Address - Country:US
Practice Address - Phone:626-796-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26307235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist