Provider Demographics
NPI:1184280125
Name:BERK, LYNN VERONICA (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:VERONICA
Last Name:BERK
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BOUNTY RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-9321
Mailing Address - Country:US
Mailing Address - Phone:330-995-2862
Mailing Address - Fax:
Practice Address - Street 1:1235 THEATRE DR SPEECH PATHLOGY AND AUDIOLOGY
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44242-0001
Practice Address - Country:US
Practice Address - Phone:330-672-2042
Practice Address - Fax:330-672-2643
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP2840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist