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General NPI Number Information
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NPI Number | 1770926719
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Entity Type | Organization
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Legal Business Name | BERRY SPEECH THERAPY
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 3810 JACKSON BLVD
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City | RAPID CITY
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State | SD
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Zip | 57702-3246
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Country | US
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Telephone | 605-484-2303
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Fax |
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Provider Business Mailing Address
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Address Line | 3810 JACKSON BLVD
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City | RAPID CITY
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State | SD
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Zip | 57702-3246
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Country | US
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Telephone | 605-484-2303
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MAGGIE KLAPPERICH
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Credential | M.S.,CCC-SLP
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Telephone | 605-484-2303
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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 | 12119970
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License Number State | SD
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