Provider Demographics
NPI:1790039279
Name:BERGH, ROBIN KING (SLPA-CC)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:KING
Last Name:BERGH
Suffix:
Gender:F
Credentials:SLPA-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-0833
Mailing Address - Country:US
Mailing Address - Phone:509-826-8148
Mailing Address - Fax:
Practice Address - Street 1:615 OAK ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-0833
Practice Address - Country:US
Practice Address - Phone:509-826-8148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP 601974392355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant