Healthcare Provider Details

I. General information

NPI: 1770065658
Provider Name (Legal Business Name): MICHELINA MARIA BERG CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 RESEARCH RD
HINGHAM MA
02043-4322
US

IV. Provider business mailing address

9 LEDGEWOOD DR
COHASSET MA
02025-2121
US

V. Phone/Fax

Practice location:
  • Phone: 781-749-7518
  • Fax:
Mailing address:
  • Phone: 617-827-5743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4027
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: