Provider Demographics
NPI:1821621889
Name:WALIA, RITU (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RITU
Middle Name:
Last Name:WALIA
Suffix:
Gender:F
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 1:12 ROYAL CT APT E
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7845
Mailing Address - Country:US
Mailing Address - Phone:609-626-2951
Mailing Address - Fax:
Practice Address - Street 1:1655 CENTERVIEW DR APT 313
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8918
Practice Address - Country:US
Practice Address - Phone:609-626-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist