MEDICARE: MRS. SHERYL SWOFFORD BERG M.A.,CCC 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	11570	TX

General Provider Information

NPI Number	:	1255344032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERYL SWOFFORD BERG M.A.,CCC SLP

Provider Business Mailing Address
First Line	:	1234 BAY AREA BLVD
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77058-2538
Country	:	US
Telephone Number	:	281-488-7221
Fax Number	:	281-488-2103

Provider Business Practice Location Address
First Line	:	1234 BAY AREA BLVD
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77058-2538
Country	:	US
Telephone Number	:	281-488-7221
Fax Number	:	281-488-2103

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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