Provider Demographics
NPI:1184990822
Name:PATHAK, SONAL (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SONAL
Middle Name:
Last Name:PATHAK
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 1:6375 GREEN VALLEY CIR UNIT 306
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-8058
Mailing Address - Country:US
Mailing Address - Phone:310-699-9484
Mailing Address - Fax:
Practice Address - Street 1:706 N DIAMOND BAR BLVD STE B
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1059
Practice Address - Country:US
Practice Address - Phone:909-861-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP19658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP19658OtherSLP BOARD-CA
CA14030887OtherASHA, AMERICAN SPEECH AND HEARING ASSOCIATION.