Kirby N Mentillo, MA CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

015179 Issued in OR

Practice address

4560 SE International Way
Suite 101
Milwaukie, OR 97222-4628

Phone

(971) 206-5202

NPI assigned

Jan 7, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389052800000",
    "number": "1124440300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9405 N RICHMOND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972031650",
            "telephone_number": "704-439-6576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4560 SE INTERNATIONAL WAY",
            "address_2": "SUITE 101",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972224628",
            "telephone_number": "971-206-5202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENTILLO",
        "first_name": "KIRBY",
        "middle_name": "N",
        "name_prefix": "Mrs.",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-07",
        "last_updated": "2014-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OR",
            "license": "015179",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL60331502",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Elizabeth Melot, COTA/L
• Julie Anna Melville, LPN
• Teresa Rose Melville, CADCI
• Angela Mendoza
• Amanda Leigh Mengel Smith, OCCUPATION THERAPIST
• Ann Marie Mentis, OTR/L
• Jeffrey Rolland Meuser, LPC
• Emily Rose Meyer, MA
• Lance Wesley Meyer
• Stuart Bredal Meyer

• Speech-Language Pathologist in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Speech-Language Pathologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.