MEDICARE: CLARA A BERRY SLP LLC

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

General Provider Information

NPI Number	:	1447970686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARA A BERRY SLP LLC

Provider Business Mailing Address
First Line	:	40 KIMBALL BEACH RD
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-1146
Country	:	US
Telephone Number	:	802-380-1564
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 KIMBALL BEACH RD
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-1146
Country	:	US
Telephone Number	:	802-380-1564
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	CLARA ADELAIDE BERRY
Credential	:	MS CCC SLP
Telephone Number	:	802-380-1564

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	08/29/2022

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