Healthcare Provider Details

I. General information

NPI: 1760309983
Provider Name (Legal Business Name): PATRICIA KHODIKIAN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 S STREET
MERCED CA
95340
US

IV. Provider business mailing address

21185 TURNER AVE
HILMAR CA
95324-9753
US

V. Phone/Fax

Practice location:
  • Phone: 209-724-2464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number38499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: