MEDICARE: DANA BETH BERG M.S., 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

General Provider Information

NPI Number	:	1750555926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA BETH BERG M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	5724 DERRY DRIVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5843
Country	:	US
Telephone Number	:	303-345-7360
Fax Number	:	303-504-9946

Provider Business Practice Location Address
First Line	:	5724 DERRY DRIVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5843
Country	:	US
Telephone Number	:	303-345-7360
Fax Number	:	303-504-9946

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

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	09/02/2011

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Directions to “ DANA BETH BERG M.S., CCC-SLP” Practice Location

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