Provider Demographics
NPI:1821251158
Name:CANTEEN, KIUANTA C (MA,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KIUANTA
Middle Name:C
Last Name:CANTEEN
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 1:779 CONCOURSE VLG E APT 7D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3714
Mailing Address - Country:US
Mailing Address - Phone:240-899-1481
Mailing Address - Fax:
Practice Address - Street 1:779 CONCOURSE VLG E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:240-899-1481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05555235Z00000X
NY028458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist