Active NPI
Gerald Lieberg, SLP
- Speech-Language Pathologist
- Duluth, MN
National Provider Identifier
1043301369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 5157
- Practice address
- 114 S 20TH Ave W
Suite a
Duluth, MN 55806-3526 - Phone
- (218) 721-4732
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 5157 | MN | Primary |
Addresses
Primary practice location
114 S 20TH Ave W
Suite a
Duluth, MN 55806-3526
Mailing address
114 S 20TH Ave W
Suite a
Duluth, MN 55806-3526
Phone (218) 721-4732
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 616055700 | Medicaid | MN | |
| HP45807 | Other | MN | HEALTH PARTNERS |
| 41D93LI | Other | MN | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490659200000",
"number": "1043301369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 S 20TH AVE W",
"address_2": "SUITE A",
"city": "DULUTH",
"state": "MN",
"postal_code": "558063526",
"telephone_number": "218-721-4732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 S 20TH AVE W",
"address_2": "SUITE A",
"city": "DULUTH",
"state": "MN",
"postal_code": "558063526",
"telephone_number": "218-721-4732"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEBERG",
"first_name": "GERALD",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2017-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "5157",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "616055700",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP45807",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "41D93LI",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.