MEDICARE: DR. CHRISTINE CELESTE BERGAN PH.D., 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	01459	IA
2	235Z00000X	Speech-Language Pathologist	106342	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	106342	OTHER	TX	TEXAS STATE LICENSE-SPEECH-LANGUAGE PATHOLOGIST

General Provider Information

NPI Number	:	1912029109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE CELESTE BERGAN PH.D., CCC-SLP

Provider Business Mailing Address
First Line	:	4141 S HULEN ST
Second Line	:	APT. 1134
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4970
Country	:	US
Telephone Number	:	319-530-7469
Fax Number	:

Provider Business Practice Location Address
First Line	:	4141 S HULEN ST
Second Line	:	APT. 1134
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4970
Country	:	US
Telephone Number	:	319-530-7469
Fax Number	:

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/29/2014

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Directions to “ DR. CHRISTINE CELESTE BERGAN PH.D., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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