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General NPI Number Information
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NPI Number | 1447767348
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Entity Type | Individual
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Provider Name | ASHLEY KRISTINE BANTEGUI SLPA
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Gender | Female
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Dates
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Enumeration Date | 01/02/2018
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Last Update Date | 04/18/2019
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Provider Practice Location Address
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Address Line | 12881 KNOTT ST STE 103
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City | GARDEN GROVE
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State | CA
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Zip | 92841-3939
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Country | US
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Telephone | 714-892-6828
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 W PROVIDENCE AVE
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City | ORANGE
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State | CA
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Zip | 92868-3892
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Country | US
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Telephone | 714-639-4990
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Fax | 714-844-3841
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 2971
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License Number State | CA
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