Provider Demographics
NPI:1245459791
Name:BERGER, MICHAEL CRAIG (SLP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CRAIG
Last Name:BERGER
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-1824
Mailing Address - Country:US
Mailing Address - Phone:620-480-9320
Mailing Address - Fax:620-210-6984
Practice Address - Street 1:1532 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-1824
Practice Address - Country:US
Practice Address - Phone:620-480-9320
Practice Address - Fax:620-210-6984
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist