Provider Demographics
NPI:1386789048
Name:HAKIMI, SUSAN ROXANNE
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ROXANNE
Last Name:HAKIMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22648 COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4402
Mailing Address - Country:US
Mailing Address - Phone:818-592-6876
Mailing Address - Fax:
Practice Address - Street 1:22648 COLLINS ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-4402
Practice Address - Country:US
Practice Address - Phone:818-592-6876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP6528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist