Provider Demographics
NPI:1851499396
Name:BERG, CYNTHIA A (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:A
Last Name:BERG
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:1838 BRANCHWATER TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8510
Mailing Address - Country:US
Mailing Address - Phone:407-281-6329
Mailing Address - Fax:407-207-8090
Practice Address - Street 1:2822 S ALAFAYA TRL
Practice Address - Street 2:SUITE 170
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7969
Practice Address - Country:US
Practice Address - Phone:321-277-5150
Practice Address - Fax:407-207-8090
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7307235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist