Provider Demographics
NPI:1093856908
Name:BERKE, MARK ELLIOT (MA CCC-A)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ELLIOT
Last Name:BERKE
Suffix:
Gender:M
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TORREY CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6743
Mailing Address - Country:US
Mailing Address - Phone:864-962-5461
Mailing Address - Fax:
Practice Address - Street 1:200 TORREY CT
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6743
Practice Address - Country:US
Practice Address - Phone:864-962-5461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3336231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist