Provider Demographics
NPI:1740028216
Name:BERTOLONE, KRISTEN (SLP, CCC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BERTOLONE
Suffix:
Gender:F
Credentials:SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2592 VIA TEJON
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-1348
Mailing Address - Country:US
Mailing Address - Phone:303-915-5334
Mailing Address - Fax:
Practice Address - Street 1:2592 VIA TEJON
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-1348
Practice Address - Country:US
Practice Address - Phone:303-915-5334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist