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General NPI Number Information
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NPI Number | 1871195602
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Entity Type | Individual
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Provider Name | JAMIE BERG CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 1425 S 1500 E
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City | CLEARFIELD
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State | UT
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Zip | 84015-1613
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Country | US
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Telephone | 385-519-5218
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Fax |
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Provider Business Mailing Address
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Address Line | 1658 BINFORD ST
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City | OGDEN
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State | UT
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Zip | 84401-3034
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Country | US
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Telephone | 435-363-5351
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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 | 10466280-4102
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License Number State | UT
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