Provider Demographics
NPI:1407097843
Name:BERRYMAN-JOHNSON, NEVERA (SLP)
Entity Type:Individual
Prefix:MS
First Name:NEVERA
Middle Name:
Last Name:BERRYMAN-JOHNSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 BONNEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-2618
Mailing Address - Country:US
Mailing Address - Phone:803-539-9418
Mailing Address - Fax:
Practice Address - Street 1:2451 BONNEVILLE DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-2618
Practice Address - Country:US
Practice Address - Phone:803-539-9418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4437235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist