Provider Demographics
NPI:1982124756
Name:KHATRI, POONAM (CF SLP)
Entity Type:Individual
Prefix:
First Name:POONAM
Middle Name:
Last Name:KHATRI
Suffix:
Gender:F
Credentials:CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15459 WILDFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9779
Mailing Address - Country:US
Mailing Address - Phone:330-631-9154
Mailing Address - Fax:
Practice Address - Street 1:15459 WILDFLOWER LN
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9779
Practice Address - Country:US
Practice Address - Phone:330-631-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty