Provider Demographics
NPI:1699034587
Name:AHMADI, MAHBOOBE (SLP)
Entity type:Individual
Prefix:MRS
First Name:MAHBOOBE
Middle Name:
Last Name:AHMADI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:MAE
Other - Middle Name:
Other - Last Name:BIDGOLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:6554 MCABEE RD.
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120
Mailing Address - Country:US
Mailing Address - Phone:408-997-3134
Mailing Address - Fax:
Practice Address - Street 1:6554 MCABEE RD.
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120
Practice Address - Country:US
Practice Address - Phone:408-997-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP11787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist