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NPI Code Detail

MEDICARE: NICOLE JEANINE KHATTAR SLP

MEDICARE: NICOLE JEANINE KHATTAR 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
1235Z00000XSpeech-Language Pathologist15665CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115665OTHERCARPE LICENSE NUMBER

General Provider Information

NPI Number : 1447822192
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE JEANINE KHATTAR SLP
Provider Business Mailing Address
First Line : 414 E SAN BERNARDINO RD
Second Line :
City : COVINA
State : CA
Zip : 91723-1704
Country : US
Telephone Number : 626-367-3206
Fax Number :
Provider Business Practice Location Address
First Line : 414 E SAN BERNARDINO RD
Second Line :
City : COVINA
State : CA
Zip : 91723-1704
Country : US
Telephone Number : 626-367-3206
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2021
Last Update Date : 04/23/2026

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Directions to “ NICOLE JEANINE KHATTAR SLP” Practice Location

Language Start Address Practice Location
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