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NPI Code Detail

MEDICARE: MR. CHRIS WENGER CCC-SLP, M.S., M.ED

MEDICARE: MR. CHRIS WENGER CCC-SLP, M.S., M.ED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist20491CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679933303
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHRIS WENGER CCC-SLP, M.S., M.ED
Provider Business Mailing Address
First Line : 10927 MANCHESTER ST
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91701-7530
Country : US
Telephone Number : 949-554-8222
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S HAVEN AVE STE 190
Second Line :
City : ONTARIO
State : CA
Zip : 91761-2971
Country : US
Telephone Number : 909-390-1313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2016
Last Update Date : 02/23/2016

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