Provider Demographics
NPI:1609208834
Name:BERGER, KARA
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4355 MARYLAND AVE
Mailing Address - Street 2:APT 419
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2737
Mailing Address - Country:US
Mailing Address - Phone:708-710-7217
Mailing Address - Fax:
Practice Address - Street 1:6820 STATE ROUTE 162
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062
Practice Address - Country:US
Practice Address - Phone:618-288-5436
Practice Address - Fax:618-288-5567
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242002813235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist