Provider Demographics
NPI:1255608899
Name:BERRY, KEISHA MATTHEWS (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:MATTHEWS
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 1:4451 PARLIAMENT PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1843
Mailing Address - Country:US
Mailing Address - Phone:301-577-4333
Mailing Address - Fax:
Practice Address - Street 1:4451 PARLIAMENT PL
Practice Address - Street 2:SUITE A
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1843
Practice Address - Country:US
Practice Address - Phone:301-577-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist