Provider Demographics
NPI:1477905032
Name:NAKAGAWA, LARA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:NAKAGAWA
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 29TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3522
Mailing Address - Country:US
Mailing Address - Phone:510-679-3545
Mailing Address - Fax:510-291-2243
Practice Address - Street 1:725 KAPIOLANI BLVD STE C206
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6024
Practice Address - Country:US
Practice Address - Phone:808-596-0099
Practice Address - Fax:808-596-0099
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23477235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist