Provider Demographics
NPI:1467577957
Name:PANTANO, KRISTY (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KRISTY
Middle Name:
Last Name:PANTANO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 CUTTER LN
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-5204
Mailing Address - Country:US
Mailing Address - Phone:908-216-1597
Mailing Address - Fax:609-242-5094
Practice Address - Street 1:1064 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST CREEK
Practice Address - State:NJ
Practice Address - Zip Code:08092-2912
Practice Address - Country:US
Practice Address - Phone:609-488-2650
Practice Address - Fax:609-488-2651
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00479900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist