Provider Demographics
NPI:1841725421
Name:KALBERG, ALISA CARRIE (MS)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:CARRIE
Last Name:KALBERG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12622 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2728
Mailing Address - Country:US
Mailing Address - Phone:805-405-6648
Mailing Address - Fax:
Practice Address - Street 1:12622 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2728
Practice Address - Country:US
Practice Address - Phone:805-405-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11302235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist