MEDICARE: JODY A BERRY MS SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	1019	WI

General Provider Information

NPI Number	:	1023234945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY A BERRY MS SLP

Provider Business Mailing Address
First Line	:	817 BARTOSH LN
Second Line	:
City	:	RIVER FALLS
State	:	WI
Zip	:	54022-2838
Country	:	US
Telephone Number	:	715-220-7832
Fax Number	:

Provider Business Practice Location Address
First Line	:	817 BARTOSH LN
Second Line	:
City	:	RIVER FALLS
State	:	WI
Zip	:	54022-2838
Country	:	US
Telephone Number	:	715-220-7832
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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Directions to “ JODY A BERRY MS SLP” Practice Location

Language	Start Address	Practice Location

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