Provider Demographics
NPI:1508289984
Name:BERRY, ROSA MARIA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIA
Last Name:BERRY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S FESTIVAL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5801
Mailing Address - Country:US
Mailing Address - Phone:915-842-1788
Mailing Address - Fax:915-842-1778
Practice Address - Street 1:109 S FESTIVAL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5801
Practice Address - Country:US
Practice Address - Phone:915-842-1788
Practice Address - Fax:915-842-1778
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX348022355S0801X
NM5759235Z00000X
NM50242355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant