Provider Demographics
NPI:1023026259
Name:BERENBERG, PHYLLIS (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:BERENBERG
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5090 RICHMOND AVE
Mailing Address - Street 2:#461
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-7402
Mailing Address - Country:US
Mailing Address - Phone:713-781-9191
Mailing Address - Fax:713-781-6114
Practice Address - Street 1:3033 CHIMNEY ROCK RD
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-6249
Practice Address - Country:US
Practice Address - Phone:713-781-9191
Practice Address - Fax:713-781-6114
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101195235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174161301Medicaid