Provider Demographics
NPI:1689761140
Name:BERGER, KIMBERLY ANNE (AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:BERGER
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:YARGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUDIOLOGIST
Mailing Address - Street 1:PO BOX 67000
Mailing Address - Street 2:DEPARTMENT 272801
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2728
Mailing Address - Country:US
Mailing Address - Phone:517-841-6913
Mailing Address - Fax:517-841-6917
Practice Address - Street 1:1111 TENEYCK ST
Practice Address - Street 2:STE 200
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2461
Practice Address - Country:US
Practice Address - Phone:517-787-1468
Practice Address - Fax:517-787-0613
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist