Provider Demographics
NPI:1265870471
Name:VENTRESS, NARISSA K (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NARISSA
Middle Name:K
Last Name:VENTRESS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10061 TALBERT AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5159
Mailing Address - Country:US
Mailing Address - Phone:714-272-3090
Mailing Address - Fax:
Practice Address - Street 1:10061 TALBERT AVE STE 103
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5159
Practice Address - Country:US
Practice Address - Phone:714-272-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8034235Z00000X
CA21706235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21706OtherCA SPEECH LANGUAGE HEARING & AUDIOLOGY BOARD