Provider Demographics
NPI:1548404528
Name:BERGER, ALISA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:
Last Name:BERGER
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 1:27 ROSALIND PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1522
Mailing Address - Country:US
Mailing Address - Phone:516-295-3867
Mailing Address - Fax:
Practice Address - Street 1:27 ROSALIND PL
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1522
Practice Address - Country:US
Practice Address - Phone:516-295-3867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011707235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist