Active NPI
Kelly Bertenshaw
- Speech-Language Pathologist
- St Louis Park, MN
National Provider Identifier
1043563570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 8926
- Practice address
- 4415 W 36 1/2 St
St Louis Park, MN 55416-4854 - Phone
- (952) 927-9717
- NPI assigned
- Oct 22, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 | 8926 | MN | Primary |
Addresses
Primary practice location
4415 W 36 1/2 St
St Louis Park, MN 55416-4854
Mailing address
7244 York Ave S
Apartment # 426
Edina, MN 55435-4455
Phone (612) 242-1220
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8926 | MN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350864000000",
"number": "1043563570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7244 YORK AVE S",
"address_2": "APARTMENT # 426",
"city": "EDINA",
"state": "MN",
"postal_code": "554354455",
"telephone_number": "612-242-1220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4415 W 36 1/2 ST",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554164854",
"telephone_number": "952-927-9717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTENSHAW",
"first_name": "KELLY",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-10-22",
"last_updated": "2012-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "8926",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.