Provider Demographics
NPI:1508356379
Name:BERRY, JOANNA YEAKEL (MS SLP)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:YEAKEL
Last Name:BERRY
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3606
Mailing Address - Country:US
Mailing Address - Phone:904-629-7949
Mailing Address - Fax:
Practice Address - Street 1:172 CANAL BLVD
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3606
Practice Address - Country:US
Practice Address - Phone:904-629-7949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8524235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist