Provider Demographics
NPI:1336547082
Name:BHAKTA, KHUSHBU (BA, SLPA)
Entity Type:Individual
Prefix:
First Name:KHUSHBU
Middle Name:
Last Name:BHAKTA
Suffix:
Gender:F
Credentials:BA, SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-3340
Mailing Address - Country:US
Mailing Address - Phone:323-839-4171
Mailing Address - Fax:
Practice Address - Street 1:2911 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-3340
Practice Address - Country:US
Practice Address - Phone:323-839-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30302355S0801X
CA29496235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant