Laura Kay Bergstrom, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

11565 Issued in OR

Practice address

4560 SE International Way Ste 100
Milwaukie, OR 97222-4628

Phone

(503) 267-4096

NPI assigned

Apr 26, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Laura Kay Greenblat Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556236800000",
    "number": "1396309159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 10TH ST",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970684626",
            "telephone_number": "503-583-4497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4560 SE INTERNATIONAL WAY STE 100",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972224628",
            "telephone_number": "503-267-4096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGSTROM",
        "first_name": "LAURA",
        "middle_name": "KAY",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-26",
        "last_updated": "2019-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OR",
            "license": "11565",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE SLP LICENSE",
            "identifier": "11565",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "GREENBLAT",
            "middle_name": "KAY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laura Kathryn Beltramo, PT
• Benchmark Physical Therapy of Or, LLC
• Judy Bennett, PT ASSISTANT
• Hailey Bentley
• Phillip Michael Bergreen, DNP, PMHNP
• Mary E Berns, SLP
• Veronica Berri
• Katherine Berry, OTR/L
• Jennifer Lynne Berryman, RN, IBCLC
• Andrew Ryan Besson, BS

• Speech-Language Pathologist in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Speech-Language Pathologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.