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General NPI Number Information
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NPI Number | 1003206798
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Entity Type | Individual
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Provider Name | KRISTINA NICHOLE BUSTAMANTE PHD, MA, BS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 302 RANDALL RD
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City | GENEVA
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State | IL
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Zip | 60134-4209
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Country | US
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Telephone | 630-938-3637
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Fax |
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Provider Business Mailing Address
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Address Line | 2981 SAVANNAH DR
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City | AURORA
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State | IL
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Zip | 60502-8690
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Country | US
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Telephone | 630-506-0426
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.012209
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License Number State | IL
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