Provider Demographics
NPI:1679933303
Name:WENGER, CHRIS (CCC-SLP, MS, MED)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:WENGER
Suffix:
Gender:M
Credentials:CCC-SLP, MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10927 MANCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-7530
Mailing Address - Country:US
Mailing Address - Phone:949-554-8222
Mailing Address - Fax:
Practice Address - Street 1:1500 S HAVEN AVE STE 190
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2971
Practice Address - Country:US
Practice Address - Phone:909-390-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA235Z00000XMedicaid