| Doctor Name: | MRS. KIRBY N MENTILLO |
| NPI Number: | 1124440300 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA CCC-SLP |
| License Number: | LL60331502 |
| Business Practice Address: | 4560 Se International Way Suite 101 Milwaukie, OR - 972224628 |
| Business Phone Number: | 9712065202 |
| Business Fax Number: | |
| Mailing Address: | 9405 N Richmond Ave, PORTLAND |
| State: | OR |
| Postal Code: | 972031650 |
| Phone Number: | 7044396576 |
| Fax Number: | |
| NPI Enumeration Date: | 01/07/2014 |
| NPI Last Update Date: | 01/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | LL60331502 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |