Provider Demographics
NPI:1023234945
Name:BERRY, JODY A (MS SLP)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:A
Last Name:BERRY
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 1:817 BARTOSH LN
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-2838
Mailing Address - Country:US
Mailing Address - Phone:715-220-7832
Mailing Address - Fax:
Practice Address - Street 1:817 BARTOSH LN
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-2838
Practice Address - Country:US
Practice Address - Phone:715-220-7832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist