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NPI Code Detail

MEDICARE: ELISSA R. BERNER ST

MEDICARE: ELISSA R. BERNER ST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist7956OH

General Provider Information

NPI Number : 1619102779
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISSA R. BERNER ST
Provider Business Mailing Address
First Line : 6276 PLATTSBURG ROAD
Second Line :
City : SOUTH CHARLESTON
State : OH
Zip : 45368-8801
Country : US
Telephone Number : 937-408-2829
Fax Number : 937-284-8186
Provider Business Practice Location Address
First Line : 6276 LONDON PLATTSBURG RD
Second Line :
City : SOUTH CHARLESTON
State : OH
Zip : 45368-8801
Country : US
Telephone Number : 937-408-2829
Fax Number : 937-284-8186
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2009
Last Update Date : 05/19/2009

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Directions to “ ELISSA R. BERNER ST” Practice Location

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