Healthcare Provider Details

I. General information

NPI: 1043590748
Provider Name (Legal Business Name): MOHITA KAUSHIK MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 12/30/2021
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39420 LIBERTY ST STE 150
FREMONT CA
94538-2284
US

IV. Provider business mailing address

2558 WASHINGTON BLVD
FREMONT CA
94539-5034
US

V. Phone/Fax

Practice location:
  • Phone: 510-794-5155
  • Fax:
Mailing address:
  • Phone: 410-206-4934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP27004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: