MEDICARE: BERTHA HERRERA M.S. 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	107547	TX

General Provider Information

NPI Number	:	1477862548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERTHA HERRERA M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	3800 N MESA ST
Second Line	:	SUITE C-7
City	:	EL PASO
State	:	TX
Zip	:	79902-1538
Country	:	US
Telephone Number	:	915-533-7787
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 N MESA ST
Second Line	:	SUITE C-7
City	:	EL PASO
State	:	TX
Zip	:	79902-1538
Country	:	US
Telephone Number	:	915-533-7787
Fax Number	:

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

Provider Enumeration Date	:	10/06/2010
Last Update Date	:	09/22/2014

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Directions to “ BERTHA HERRERA M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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