Provider Demographics
NPI:1629124839
Name:LAKKANNA, SUDHAMANI HOSAHALLI (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUDHAMANI
Middle Name:HOSAHALLI
Last Name:LAKKANNA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40878 MARTY TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-4459
Mailing Address - Country:US
Mailing Address - Phone:510-565-4596
Mailing Address - Fax:
Practice Address - Street 1:200 BROWN RD
Practice Address - Street 2:SUITE #204
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7955
Practice Address - Country:US
Practice Address - Phone:510-565-4596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 1622231H00000X
CASP 8678235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist