Provider Demographics
NPI:1619124336
Name:BERG, SARA M
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:M
Last Name:BERG
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 1:768 E MARIAH HILL RD
Mailing Address - Street 2:
Mailing Address - City:FERDINAND
Mailing Address - State:IN
Mailing Address - Zip Code:47532-9737
Mailing Address - Country:US
Mailing Address - Phone:217-497-4958
Mailing Address - Fax:
Practice Address - Street 1:768 E MARIAH HILL RD
Practice Address - Street 2:
Practice Address - City:FERDINAND
Practice Address - State:IN
Practice Address - Zip Code:47532-9737
Practice Address - Country:US
Practice Address - Phone:217-497-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL37068625001Medicaid
IL37068625001Medicaid