Doctor Name: | MS. KELLY BERTENSHAW |
NPI Number: | 1043563570 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 8926 |
Business Practice Address: | 4415 W 36 1/2 St St Louis Park, MN - 554164854 |
Business Phone Number: | 9529279717 |
Business Fax Number: | |
Mailing Address: | 7244 York Ave S, Apartment # 426 EDINA |
State: | MN |
Postal Code: | 554354455 |
Phone Number: | 6122421220 |
Fax Number: | |
NPI Enumeration Date: | 10/22/2012 |
NPI Last Update Date: | 10/22/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 8926 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
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 |