Active NPI
Sally Bern
- Speech-Language Pathologist
- Castle Rock, WA
National Provider Identifier
1194156190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- LL60405634
- Practice address
- 700 Huntington Ave S
Castle Rock, WA 98611-8902 - Phone
- (360) 501-2910
- NPI assigned
- Dec 2, 2013
- 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 | LL60405634 | WA | Primary |
Addresses
Primary practice location
700 Huntington Ave S
Castle Rock, WA 98611-8902
Mailing address
700 Huntington Ave S
Castle Rock, WA 98611-8902
Phone (360) 501-2910
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 |
|---|---|---|---|
| LL60405634 | WA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1385942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1385942400000",
"number": "1194156190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 HUNTINGTON AVE S",
"city": "CASTLE ROCK",
"state": "WA",
"postal_code": "986118902",
"telephone_number": "360-501-2910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 HUNTINGTON AVE S",
"city": "CASTLE ROCK",
"state": "WA",
"postal_code": "986118902",
"telephone_number": "360-501-2910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERN",
"first_name": "SALLY",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-02",
"last_updated": "2013-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WA",
"license": "LL60405634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Castle Rock, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.