Provider Demographics
NPI:1487954251
Name:HERRERA, BERTHA L (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:L
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 PINEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6414
Mailing Address - Country:US
Mailing Address - Phone:908-810-9677
Mailing Address - Fax:
Practice Address - Street 1:737 PINEWOOD RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6414
Practice Address - Country:US
Practice Address - Phone:908-810-9677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016602235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist