Provider Demographics
NPI:1689245144
Name:BERRY, STEPHANIE ALYSSA (AUD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ALYSSA
Last Name:BERRY
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 1:15400 SOUTHWEST FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3877
Mailing Address - Country:US
Mailing Address - Phone:480-238-2695
Mailing Address - Fax:
Practice Address - Street 1:15400 SOUTHWEST FWY STE 200
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3877
Practice Address - Country:US
Practice Address - Phone:281-494-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty