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General NPI Number Information
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NPI Number | 1457127193
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Entity Type | Individual
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Provider Name | SARA BERRY MA CCC SLP
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Gender | Female
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 94-1181 KA UKA BLVD STE C
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City | WAIPAHU
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State | HI
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Zip | 96797-4485
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Country | US
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Telephone | 808-260-9056
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Fax |
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Provider Business Mailing Address
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Address Line | 160 KEONEKAI ROAD BULIDING 4, #102
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City | KIHEI
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State | HI
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Zip | 96753
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Country | US
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Telephone | 573-631-0636
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2140
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License Number State | HI
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