Provider Demographics
NPI:1073053617
Name:BERG, CHESSIE ELIZABETH (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHESSIE
Middle Name:ELIZABETH
Last Name:BERG
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 1:325 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-8654
Mailing Address - Country:US
Mailing Address - Phone:662-910-1437
Mailing Address - Fax:
Practice Address - Street 1:325 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-8654
Practice Address - Country:US
Practice Address - Phone:662-910-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#3542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist