Provider Demographics
NPI:1821261520
Name:IWAHASHI, MASAYUKI (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:MASAYUKI
Middle Name:
Last Name:IWAHASHI
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 HOLCOMB SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5334
Mailing Address - Country:US
Mailing Address - Phone:404-431-8360
Mailing Address - Fax:
Practice Address - Street 1:404 KING SPRINGS VILLAGE PKWY SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-4240
Practice Address - Country:US
Practice Address - Phone:770-431-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006220235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP006220OtherSTATE BOARD OF EXAMINERS