Provider Demographics
NPI:1568107993
Name:GANESAN, KRITHIKA (MS-SLP)
Entity Type:Individual
Prefix:
First Name:KRITHIKA
Middle Name:
Last Name:GANESAN
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11594 WINDCREST LN APT 2214
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-6426
Mailing Address - Country:US
Mailing Address - Phone:925-967-6136
Mailing Address - Fax:
Practice Address - Street 1:11594 WINDCREST LN APT 2214
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-6426
Practice Address - Country:US
Practice Address - Phone:925-967-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33641235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist