Shelley Lea Bergman, M.A.,CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Hannibal, MO
NPI 1114094463 · NPPES record last updated Nov 13, 2013
Key facts
- NPI
- 1114094463
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- HE114933 (MO)
- Practice address
- 6000 Hospital Dr
Hannibal, MO 63401-6887 - Phone
- (573) 406-5777
- NPI assigned
- Nov 30, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HE114933 | MO | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | HE114933 | MO | Yes |
Addresses
Primary practice location
6000 Hospital Dr
Hannibal, MO 63401-6887
Mailing address
215 S Meyer Rd
Quincy, IL 62305-8018
Phone (217) 224-2487
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 469804124 | Medicaid | MO |
Other providers in Hannibal, MO
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- John R Bennett
- Leanne Marie Berry
- Best Buy Homecare of Louisiana, Inc
- Charlotte Maureen Best
- Jerry Michael Best
- Robert Steven Best
All providers in Hannibal, MO · Speech-Language Pathologist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.