Provider Demographics
NPI:1457415614
Name:BERGER, REBECCA L (AUD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
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 1:2930 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-8083
Mailing Address - Country:US
Mailing Address - Phone:574-935-4327
Mailing Address - Fax:574-935-4327
Practice Address - Street 1:2930 MILLER DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-8083
Practice Address - Country:US
Practice Address - Phone:574-935-4327
Practice Address - Fax:574-935-4327
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN512270EOtherRR MEDICARE
IN264180RMedicare PIN
IN100338280Medicaid
IN00000085513OtherANTHEM PIN
IN739280Medicare PIN