Provider Demographics
NPI:1609056613
Name:BHATIA, AVANTI LAL (MS)
Entity type:Individual
Prefix:MRS
First Name:AVANTI
Middle Name:LAL
Last Name:BHATIA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:AVANTI
Other - Middle Name:
Other - Last Name:LAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1457 GREENHILL CT
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81657-5325
Mailing Address - Country:US
Mailing Address - Phone:847-650-8174
Mailing Address - Fax:970-470-4272
Practice Address - Street 1:1457 GREENHILL CT
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-5325
Practice Address - Country:US
Practice Address - Phone:847-650-8174
Practice Address - Fax:970-470-4272
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2420007252355S0801X
COSLP.0001843235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant