Provider Demographics
NPI:1942515606
Name:BERGER, LEEANN (AUD)
Entity Type:Individual
Prefix:DR
First Name:LEEANN
Middle Name:
Last Name:BERGER
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 1:671 3RD AVE
Mailing Address - Street 2:A2
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3652
Mailing Address - Country:US
Mailing Address - Phone:812-630-6716
Mailing Address - Fax:
Practice Address - Street 1:671 3RD AVE
Practice Address - Street 2:A2
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3652
Practice Address - Country:US
Practice Address - Phone:812-630-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002482A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist