Provider Demographics
NPI:1538370457
Name:BERRY, LINDI RENEA (AUD)
Entity type:Individual
Prefix:
First Name:LINDI
Middle Name:RENEA
Last Name:BERRY
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:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-920-0068
Practice Address - Street 1:923 PENNSYLVANIA AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2254
Practice Address - Country:US
Practice Address - Phone:817-920-0484
Practice Address - Fax:817-920-0068
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60530231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186205401Medicaid
TX186205402OtherMEDICAID CSHCN
P00422596OtherRAILROAD MEDICARE