Provider Demographics
NPI:1700692548
Name:BERGER, LAURA (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 OCEAN LANE DR APT 206
Mailing Address - Street 2:
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-1424
Mailing Address - Country:US
Mailing Address - Phone:704-607-2456
Mailing Address - Fax:
Practice Address - Street 1:7400 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7700
Practice Address - Country:US
Practice Address - Phone:786-751-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA20382235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist