Provider Demographics
NPI:1063887255
Name:BERTONE SPEECH LANGUAGE & COMMUNICATION SERVICES
Entity type:Organization
Organization Name:BERTONE SPEECH LANGUAGE & COMMUNICATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-454-8692
Mailing Address - Street 1:11606 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2009
Mailing Address - Country:US
Mailing Address - Phone:952-544-0349
Mailing Address - Fax:
Practice Address - Street 1:11606 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2009
Practice Address - Country:US
Practice Address - Phone:952-544-0349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty