Provider Demographics
NPI:1760157093
Name:THADANI, ALISHA (RBT)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:THADANI
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 GREENFERN CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5000 RESEARCH CT STE 450
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6660
Practice Address - Country:US
Practice Address - Phone:770-205-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2025-03-31
Deactivation Date:2024-11-07
Deactivation Code:
Reactivation Date:2024-12-03
Provider Licenses
StateLicense IDTaxonomies
GARBT-21-179514106S00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician