Provider Demographics
NPI:1730539925
Name:PEREZ, BERENICE G
Entity type:Individual
Prefix:
First Name:BERENICE
Middle Name:G
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1321
Mailing Address - Country:US
Mailing Address - Phone:708-612-7288
Mailing Address - Fax:708-255-2391
Practice Address - Street 1:3109 PARK AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1321
Practice Address - Country:US
Practice Address - Phone:708-612-7288
Practice Address - Fax:708-255-2391
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2170003442355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant