MEDICARE: SUSANE MORAN NISHIKAWA M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP29406	CA

General Provider Information

NPI Number	:	1134060221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANE MORAN NISHIKAWA M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2646 LEVANTE ST
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-8118
Country	:	US
Telephone Number	:	760-415-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S RANCHO SANTA FE RD
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-4349
Country	:	US
Telephone Number	:	760-944-4300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2026
Last Update Date	:	04/06/2026

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Directions to “ SUSANE MORAN NISHIKAWA M.S., CCC-SLP” Practice Location

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