Provider Demographics
NPI:1477608495
Name:BERG, RUTH ROMA (BA)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ROMA
Last Name:BERG
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 NORTHWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77303
Mailing Address - Country:US
Mailing Address - Phone:936-539-4640
Mailing Address - Fax:936-539-1505
Practice Address - Street 1:704 LONGMIRE ROAD SUITE 101
Practice Address - Street 2:BEYOND BOUNDARIES THERAPY CENTER
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-441-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist