Provider Demographics
NPI:1225012594
Name:VON BERG, SHELLY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:L
Last Name:VON BERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 N VIRGINIA
Mailing Address - Street 2:REDFIELD MEDICAL BUILDING MAIL STOP 152
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89557-0274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1664 N VIRGINIA
Practice Address - Street 2:REDFIELD MEDICAL BUILDING MAIL STOP 152
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557-0274
Practice Address - Country:US
Practice Address - Phone:775-784-4887
Practice Address - Fax:775-784-4095
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP580235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist