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General NPI Number Information
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NPI Number | 1336340439
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Entity Type | Individual
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Provider Name | MRS. KELLY MICHELLE BERNING
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Gender | Female
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 610 TEXAS BLVD
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City | BETHALTO
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State | IL
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Zip | 62010-1754
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Country | US
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Telephone | 618-377-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 13 SIERRA DR
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City | GLEN CARBON
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State | IL
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Zip | 62034-1302
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Country | US
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Telephone | 618-604-1572
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 146.006479
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License Number State | IL
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