Provider Demographics
NPI:1013348317
Name:JAYARAJAN, JAYAKUMAR (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:JAYAKUMAR
Middle Name:
Last Name:JAYARAJAN
Suffix:
Gender:M
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11124 DONNELLY ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-7734
Mailing Address - Country:US
Mailing Address - Phone:909-908-1292
Mailing Address - Fax:
Practice Address - Street 1:11124 DONNELLY ST
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-7734
Practice Address - Country:US
Practice Address - Phone:909-908-1292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP15876235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist