MEDICARE: CARLA YOUNGDAHL BERG CCC-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
1	235Z00000X	Speech-Language Pathologist	8586	OH

General Provider Information

NPI Number	:	1215135512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA YOUNGDAHL BERG CCC-SLP

Provider Business Mailing Address
First Line	:	264 CRANDALL DR
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-4006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3680 DOLSON CT
Second Line	:
City	:	CARROLL
State	:	OH
Zip	:	43112-9721
Country	:	US
Telephone Number	:	740-654-0641
Fax Number	:	740-654-3896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2007
Last Update Date	:	07/08/2007

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Directions to “ CARLA YOUNGDAHL BERG CCC-SLP” Practice Location

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