Berg, Carl Stacey

Berg, Carl Stacey is an individual health care provider with primary practice located at 1867 Williams Hwy Suite 105, Grants Pass OR 97527-5854. He recently has only one registered license in Speech, Language and Hearing Service Providers / Audiologist, which is considered as his primary health care specialty. Berg, Carl Stacey can be contacted via phone (541) 474-4694.

Contact Information

Primary practice address
1867 Williams Hwy Suite 105 Grants Pass OR 97527-5854
Phone: (541) 474-4694
Fax: (541) 474-9590
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Audiologist 231H00000X 20545 Oregon

Profile Details

NPI number 1063454114
LBN Legal business name Berg, Carl Stacey
Credentials MASTER OF SCIENCE MS
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 12th, 2006
Last updated Sep 10th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063454114 NPPES
Oregon MEDICAID 283606

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