Provider Demographics
NPI:1740830025
Name:BERGERON, TERRYN (SLP, MS-CCC)
Entity type:Individual
Prefix:
First Name:TERRYN
Middle Name:
Last Name:BERGERON
Suffix:
Gender:F
Credentials:SLP, MS-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 SAGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7131
Mailing Address - Country:US
Mailing Address - Phone:985-381-3371
Mailing Address - Fax:
Practice Address - Street 1:3406 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4148
Practice Address - Country:US
Practice Address - Phone:346-570-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105623235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist