MEDICARE: EMILY BERGMAN M.A., 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	06985	MD

General Provider Information

NPI Number	:	1770959785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY BERGMAN M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	300 UNIVERSITY BLVD E
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-2866
Country	:	US
Telephone Number	:	240-740-6280
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 UNIVERSITY BLVD E
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-2866
Country	:	US
Telephone Number	:	240-740-6280
Fax Number	:

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

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	09/03/2024

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