Active NPI
Christine Celeste Bergan, PH.D., CCC-SLP
- Speech-Language Pathologist
- Fort Worth, TX
National Provider Identifier
1912029109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 106342
- Practice address
- 4141 S Hulen St
Apt. 1134
Fort Worth, TX 76109-4970 - Phone
- (319) 530-7469
- NPI assigned
- Apr 6, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 01459 | IA | |
| Speech-Language Pathologist | 235Z00000X | 106342 | TX | Primary |
Addresses
Primary practice location
4141 S Hulen St
Apt. 1134
Fort Worth, TX 76109-4970
Mailing address
4141 S Hulen St
Apt. 1134
Fort Worth, TX 76109-4970
Phone (319) 530-7469
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 106342 | Other | TX | TEXAS STATE LICENSE-SPEECH-LANGUAGE PATHOLOGIST |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01459 | IA | MD | Speech-Language Pathologist |
| 106342 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406592000000",
"number": "1912029109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4141 S HULEN ST",
"address_2": "APT. 1134",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761094970",
"telephone_number": "319-530-7469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4141 S HULEN ST",
"address_2": "APT. 1134",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761094970",
"telephone_number": "319-530-7469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGAN",
"first_name": "CHRISTINE",
"middle_name": "CELESTE",
"name_prefix": "Dr.",
"credential": "PH.D., CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-06",
"last_updated": "2014-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IA",
"license": "01459",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "106342",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS STATE LICENSE-SPEECH-LANGUAGE PATHOLOGIST",
"identifier": "106342",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.