Provider Demographics
NPI:1073619003
Name:BERG, ALYCIA K (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALYCIA
Middle Name:K
Last Name:BERG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 ESTATE SMITH BAY STE 334
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-1324
Mailing Address - Country:US
Mailing Address - Phone:340-714-2348
Mailing Address - Fax:
Practice Address - Street 1:6115 ESTATE SMITH BAY STE 334
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-1324
Practice Address - Country:US
Practice Address - Phone:340-714-2348
Practice Address - Fax:781-647-8914
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6906235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist