Provider Demographics
NPI:1528209947
Name:BERTACINI, RICHARD MARTIN (BC - HIS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MARTIN
Last Name:BERTACINI
Suffix:
Gender:M
Credentials:BC - HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7131 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-2762
Mailing Address - Country:US
Mailing Address - Phone:402-440-0976
Mailing Address - Fax:402-466-5336
Practice Address - Street 1:112 S 19TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-4259
Practice Address - Country:US
Practice Address - Phone:402-228-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-14
Last Update Date:2009-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE699237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist