Provider Demographics
NPI:1689395584
Name:BERGER, KATHRYN MARY (MS-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MARY
Last Name:BERGER
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 WILLMANS WAY
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-4255
Mailing Address - Country:US
Mailing Address - Phone:410-991-3614
Mailing Address - Fax:
Practice Address - Street 1:8820 RIXLEW LN
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3733
Practice Address - Country:US
Practice Address - Phone:703-365-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000971235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist