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NPI Code Detail

MEDICARE: MR. STEPHEN GERARD EBERT SLP

MEDICARE:  MR. STEPHEN GERARD EBERT  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 Pathologist5782MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1HP43123OTHERMNHEALTH PARTNERS
220F98EBOTHERMNBCBS MN

General Provider Information

NPI Number : 1871711697
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEPHEN GERARD EBERT SLP
Provider Business Mailing Address
First Line : 204 LEWIS AVE S
Second Line : STE 210
City : WATERTOWN
State : MN
Zip : 55388-4500
Country : US
Telephone Number : 952-955-2242
Fax Number : 952-955-2010
Provider Business Practice Location Address
First Line : 2060 UPPER 55TH ST E
Second Line :
City : INVER GROVE HEIGHTS
State : MN
Zip : 55077-1725
Country : US
Telephone Number : 952-955-2242
Fax Number : 952-955-2010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2007
Last Update Date : 07/08/2007

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Directions to “ MR. STEPHEN GERARD EBERT SLP” Practice Location

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