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General NPI Number Information
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NPI Number | 1477608495
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Entity Type | Individual
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Provider Name | RUTH ROMA BERG BA
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 704 LONGMIRE ROAD SUITE 101 BEYOND BOUNDARIES THERAPY CENTER
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City | CONROE
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State | TX
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Zip | 77304
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Country | US
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Telephone | 936-441-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 610 NORTHWOOD DRIVE
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City | CONROE
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State | TX
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Zip | 77303
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Country | US
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Telephone | 936-539-4640
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Fax | 936-539-1505
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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 | 10625
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License Number State | TX
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