Provider Demographics
NPI:1093298648
Name:BERESZNIEWICZ, ALLEGRA ROSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLEGRA ROSE
Middle Name:
Last Name:BERESZNIEWICZ
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 1:2075 CHARLOTTE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-2729
Mailing Address - Country:US
Mailing Address - Phone:406-556-9853
Mailing Address - Fax:406-219-3223
Practice Address - Street 1:2075 CHARLOTTE ST STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2729
Practice Address - Country:US
Practice Address - Phone:406-556-9853
Practice Address - Fax:406-219-3223
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77309235Z00000X
235Z00000X
MT9662235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist