Provider Demographics
NPI:1396392114
Name:GANDHI, RADHIKA
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:GANDHI
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 1:12814 COPPER CLIFF AVE APT B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-4309
Mailing Address - Country:US
Mailing Address - Phone:806-300-2483
Mailing Address - Fax:
Practice Address - Street 1:1909 ALEX AVE APT A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6363
Practice Address - Country:US
Practice Address - Phone:806-300-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120981235Z00000X
CASP34122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist