Healthcare Provider Details

I. General information

NPI: 1962997502
Provider Name (Legal Business Name): RASIKA M MOHAN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 MIDDLESEX TPKE
OLD SAYBROOK CT
06475-1220
US

IV. Provider business mailing address

22 SILO HL
MADISON CT
06443-8207
US

V. Phone/Fax

Practice location:
  • Phone: 860-388-8300
  • Fax:
Mailing address:
  • Phone: 774-444-3666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number007629
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: