Doctor Name: | DR. SHELLY L VON BERG |
NPI Number: | 1225012594 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | SP580 |
Business Practice Address: | 1664 N Virginia Redfield Medical Building Mail Stop 152 Reno, NV - 895570274 |
Business Phone Number: | 7757844887 |
Business Fax Number: | 7757844095 |
Mailing Address: | 1664 N Virginia, Redfield Medical Building Mail Stop 152 RENO |
State: | NV |
Postal Code: | 895570274 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/01/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SP580 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NV |
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 |