Provider Demographics
NPI:1134140619
Name:BERKS HEARING PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:BERKS HEARING PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER/AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRUDERECK
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:610-286-1999
Mailing Address - Street 1:321 NORTH FURNACE STREET SUITE 90
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508
Mailing Address - Country:US
Mailing Address - Phone:610-404-8025
Mailing Address - Fax:610-404-8045
Practice Address - Street 1:321 NORTH FURNACE STREET SUITE 90
Practice Address - Street 2:
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508
Practice Address - Country:US
Practice Address - Phone:610-404-8025
Practice Address - Fax:610-404-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005180231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2772194000OtherINDEPENDENCE BLUE CROSS
PA1019035640001Medicaid
PA1902580OtherHIGHMARK BLUE SHIELD
PA2772194000OtherINDEPENDENCE BLUE CROSS