Provider Demographics
NPI:1972550200
Name:BERNDTSON, DEBORAH L (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:BERNDTSON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LEFRAK HALL
Mailing Address - Street 2:UNIVERSITY OF MARYLAND
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20742-8211
Mailing Address - Country:US
Mailing Address - Phone:301-405-5562
Mailing Address - Fax:301-314-2023
Practice Address - Street 1:100 LEFRAK HALL
Practice Address - Street 2:UNIVERSITY OF MARYLAND
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742-8211
Practice Address - Country:US
Practice Address - Phone:301-405-5562
Practice Address - Fax:301-314-2023
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01187237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010240557Medicaid
VA010240557Medicaid