Basha Ontiveros, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146007682 Issued in IL

Practice address

2416 E Washington St Ste C5
Bloomington, IL 61704-1629

Phone

(913) 730-5925

Fax

(202) 931-7876

NPI assigned

Jul 30, 2006

Last updated

Aug 22, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bloomington-Normal Speech Therapy LLC

  • Speech-Language Pathologist
  • Bloomington, IL
  • NPI 1336745892
  NPD Authorized official

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661126400000",
    "number": "1629083423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 IMPERIAL DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617012029",
            "telephone_number": "309-830-5925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2416 E WASHINGTON ST STE C5",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617041629",
            "telephone_number": "913-730-5925",
            "fax_number": "202-931-7876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ONTIVEROS",
        "first_name": "BASHA",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-30",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146007682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "5732059",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annabelle L Ogerio, PT
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• Yaw Opoku-Agyemang, APN
• Optim Dental Bloomington LLC
• Hannah Elizabeth Ortell
• Orthopedic and Sports Enhancement Center, LLC
• Orthopedic Rehabilitation Supply LLC

• Speech-Language Pathologist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; 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.