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NPI Code Detail

MEDICARE: DAVID TRENT CASBERG M.A., ED., SLP

MEDICARE: DAVID TRENT CASBERG M.A., ED., SLP
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 Pathologist11782CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111782OTHERCACALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS

General Provider Information

NPI Number : 1093241937
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID TRENT CASBERG M.A., ED., SLP
Provider Business Mailing Address
First Line : 533 PINE ST
Second Line :
City : SOLVANG
State : CA
Zip : 93463-2626
Country : US
Telephone Number : 805-895-0354
Fax Number :
Provider Business Practice Location Address
First Line : 533 PINE ST
Second Line :
City : SOLVANG
State : CA
Zip : 93463-2626
Country : US
Telephone Number : 805-895-0354
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2017
Last Update Date : 05/11/2017

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