Provider Demographics
NPI:1902407554
Name:IFTIKHAR, AISHA ALI (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:ALI
Last Name:IFTIKHAR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 BITTERSWEET DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4078
Mailing Address - Country:US
Mailing Address - Phone:540-840-3724
Mailing Address - Fax:
Practice Address - Street 1:514 BITTERSWEET DR
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-4078
Practice Address - Country:US
Practice Address - Phone:540-840-3724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12160371235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist