Healthcare Provider Details

I. General information

NPI: 1497884704
Provider Name (Legal Business Name): AUDREY BERK MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11602 LAKE UNDERHILL RD SUITE 129
ORLANDO FL
32825-4458
US

IV. Provider business mailing address

5104 JEANNINE CT
ORLANDO FL
32807-1366
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-5400
  • Fax: 321-281-4942
Mailing address:
  • Phone: 941-914-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA8920
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: