Provider Demographics
NPI:1942798921
Name:IYENGAR, RAJASHRI ANAND (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RAJASHRI
Middle Name:ANAND
Last Name:IYENGAR
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 1:445 CALISTOGA CIR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-7622
Mailing Address - Country:US
Mailing Address - Phone:510-673-1768
Mailing Address - Fax:
Practice Address - Street 1:445 CALISTOGA CIR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-7622
Practice Address - Country:US
Practice Address - Phone:510-673-1768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist