Provider Demographics
NPI:1396111381
Name:SOMAN, BAKUL (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BAKUL
Middle Name:
Last Name:SOMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 APPLE CART WAY
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7489
Mailing Address - Country:US
Mailing Address - Phone:650-430-2830
Mailing Address - Fax:
Practice Address - Street 1:106 APPLE CART WAY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-7489
Practice Address - Country:US
Practice Address - Phone:650-430-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist