Provider Demographics
NPI:1336340439
Name:BERNING, KELLY MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MICHELLE
Last Name:BERNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1302
Mailing Address - Country:US
Mailing Address - Phone:618-604-1572
Mailing Address - Fax:
Practice Address - Street 1:610 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:BETHALTO
Practice Address - State:IL
Practice Address - Zip Code:62010-1754
Practice Address - Country:US
Practice Address - Phone:618-377-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006479235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist