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General NPI Number Information
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NPI Number | 1063887255
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Entity Type | Organization
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Legal Business Name | BERTONE SPEECH LANGUAGE & COMMUNICATION SERVICES
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Dates
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Enumeration Date | 12/14/2015
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 11606 WAYZATA BLVD
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City | MINNETONKA
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State | MN
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Zip | 55305-2009
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Country | US
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Telephone | 952-544-0349
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Fax |
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Provider Business Mailing Address
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Address Line | 11606 WAYZATA BLVD
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City | MINNETONKA
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State | MN
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Zip | 55305-2009
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Country | US
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Telephone | 952-544-0349
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TARA BERTONE
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Credential |
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Telephone | 612-454-8692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7587
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License Number State | MN
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