MEDICARE: MS. BERTHA ANDERSON M.S.,CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	18802	TX

General Provider Information

NPI Number	:	1659651495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BERTHA ANDERSON M.S.,CCC-SLP

Provider Business Mailing Address
First Line	:	1340 JAMES CRAVENS CT.
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936
Country	:	US
Telephone Number	:	915-494-5412
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 N. ZARAGOZA STE.A-11
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936
Country	:	US
Telephone Number	:	915-855-0601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	08/25/2011

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