Provider Demographics
NPI:1609056787
Name:CHELBERG, INGRID KATRINA (MA)
Entity type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:KATRINA
Last Name:CHELBERG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 CINNAMON FERN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOHN
Mailing Address - State:FL
Mailing Address - Zip Code:32927-3434
Mailing Address - Country:US
Mailing Address - Phone:321-626-2555
Mailing Address - Fax:
Practice Address - Street 1:1486 SWANSON DR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7873
Practice Address - Country:US
Practice Address - Phone:321-626-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist