Provider Demographics
NPI:1528203486
Name:PANTALENA, KIRSTEN ANNE (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:ANNE
Last Name:PANTALENA
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:MISS
Other - First Name:KIRSTEN
Other - Middle Name:ANNE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:1019 RIPLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1643
Mailing Address - Country:US
Mailing Address - Phone:908-232-1032
Mailing Address - Fax:
Practice Address - Street 1:1019 RIPLEY AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1643
Practice Address - Country:US
Practice Address - Phone:908-232-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012055-1235Z00000X
NJ41YS00408600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist