Provider Demographics
NPI:1568508653
Name:BERO, JUDY ANN (AUD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:ANN
Last Name:BERO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 SE 24TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-3314
Mailing Address - Country:US
Mailing Address - Phone:239-470-3812
Mailing Address - Fax:
Practice Address - Street 1:4550 COLONIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1017
Practice Address - Country:US
Practice Address - Phone:239-931-5712
Practice Address - Fax:239-931-5738
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 819231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist