MEDICARE: SHANNON KLIMAS BERNITT

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	1473	NE

General Provider Information

NPI Number	:	1992085385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON KLIMAS BERNITT

Provider Business Mailing Address
First Line	:	1724 W CHARLES ST
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-5901
Country	:	US
Telephone Number	:	607-765-2450
Fax Number	:

Provider Business Practice Location Address
First Line	:	1724 W CHARLES ST
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-5901
Country	:	US
Telephone Number	:	607-765-2450
Fax Number	:

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

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	07/15/2020

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Directions to “ SHANNON KLIMAS BERNITT ” Practice Location

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