Miranda J Gullberg, MS, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Biggsville, IL
NPI 1194249268 · NPPES record last updated Jul 31, 2017
Key facts
- NPI
- 1194249268
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 146012643 (IL)
- Practice address
- 1514 US Route 34
Biggsville, IL 61418-5012 - Phone
- (309) 627-2339
- NPI assigned
- Jul 31, 2017
- Sex
- Female
- Sole proprietor
- No
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 Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146012643 | IL | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146012643 | IL | Yes |
Addresses
Primary practice location
1514 US Route 34
Biggsville, IL 61418-5012
Mailing address
1514 US Route 34
Biggsville, IL 61418-5012
Phone (309) 627-2339
Other names
- Miranda J Clark
Other providers in Biggsville, IL
- Shaila Ayer
- Biggsville Ambulance Service
- Good Dental Care
- Brian Anthony Good
- Catherine Good
- Mallory Nelson
- Paige Morgan Torrance
- West Central Cusd 235
All providers in Biggsville, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2017. 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.