Provider Demographics
NPI:1093241937
Name:CASBERG, DAVID TRENT (MA, ED, SLP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TRENT
Last Name:CASBERG
Suffix:
Gender:M
Credentials:MA, ED, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-2626
Mailing Address - Country:US
Mailing Address - Phone:805-895-0354
Mailing Address - Fax:
Practice Address - Street 1:533 PINE ST
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2626
Practice Address - Country:US
Practice Address - Phone:805-895-0354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11782235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11782OtherCALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS