Provider Demographics
NPI:1588389308
Name:THIRUNAVUKARASU, SELVI
Entity type:Individual
Prefix:
First Name:SELVI
Middle Name:
Last Name:THIRUNAVUKARASU
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 1:6801 LEISURE TOWN RD APT 153
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-9447
Mailing Address - Country:US
Mailing Address - Phone:917-657-0900
Mailing Address - Fax:
Practice Address - Street 1:6801 LEISURE TOWN RD APT 153
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-9447
Practice Address - Country:US
Practice Address - Phone:917-657-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP20655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist