Provider Demographics
NPI:1174261226
Name:BERRY, ALEXANDRIA (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:ALEXANDRIA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1241
Mailing Address - Country:US
Mailing Address - Phone:217-972-0081
Mailing Address - Fax:
Practice Address - Street 1:805 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2522
Practice Address - Country:US
Practice Address - Phone:217-326-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.015895235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist