Provider Demographics
NPI:1740867431
Name:BERARD, SPENCER RYAN (MA CF-SLP)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:RYAN
Last Name:BERARD
Suffix:
Gender:M
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20309 SILKTASSEL RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-3058
Mailing Address - Country:US
Mailing Address - Phone:951-707-7519
Mailing Address - Fax:
Practice Address - Street 1:20309 SILKTASSEL RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-3058
Practice Address - Country:US
Practice Address - Phone:951-707-7519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15429235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty