Provider Demographics
NPI:1821415498
Name:KINTNER, ASHA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:KINTNER
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 1:5183 N 800 E
Mailing Address - Street 2:
Mailing Address - City:WILKINSON
Mailing Address - State:IN
Mailing Address - Zip Code:46186-9684
Mailing Address - Country:US
Mailing Address - Phone:317-439-3763
Mailing Address - Fax:
Practice Address - Street 1:5183 N 800 E
Practice Address - Street 2:
Practice Address - City:WILKINSON
Practice Address - State:IN
Practice Address - Zip Code:46186-9684
Practice Address - Country:US
Practice Address - Phone:317-439-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003427A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist