Provider Demographics
NPI:1477923910
Name:BERRY, BRIANNA (MS CCC SLP/L)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:MS CCC SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9299 W DOCKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-8619
Mailing Address - Country:US
Mailing Address - Phone:317-502-5154
Mailing Address - Fax:765-378-9019
Practice Address - Street 1:9299 W DOCKSIDE CIR
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-8619
Practice Address - Country:US
Practice Address - Phone:317-502-5154
Practice Address - Fax:765-378-9019
Is Sole Proprietor?:No
Enumeration Date:2015-09-27
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006213A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist