Basic Information
| Provider Information | |||||||||
| NPI: | 1063991081 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERG | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | STEELE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.S.ED. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4744 41ST AVE SW APT 116 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981164535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182274016 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4800 SAND POINT WAY NE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981053901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069872000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2018 | ||||||||
| LastUpdateDate: | 01/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 027884-1 | NY | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | LL60938424 | WA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | LL60938424 | 01 | WA | SPEECH LANGUAGE PATHOLOGIST LICENSE | OTHER | 027884-1 | 01 | NY | NYS SPEECH-LANGUAGE PATHOLOGY LICENSE | OTHER |