Provider Demographics
NPI:1063780385
Name:THAKKAR, BHAIRAVI KIRTI (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BHAIRAVI
Middle Name:KIRTI
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 BIRMINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3167
Mailing Address - Country:US
Mailing Address - Phone:570-317-3436
Mailing Address - Fax:
Practice Address - Street 1:648 N RIVER RD STE 102
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8968
Practice Address - Country:US
Practice Address - Phone:331-247-7322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010048235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist