Provider Demographics
NPI:1285492314
Name:BERKOWITZ, CARYN (MHS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:MHS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 NOTTING HILL DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-8200
Mailing Address - Country:US
Mailing Address - Phone:573-228-0695
Mailing Address - Fax:
Practice Address - Street 1:550 STONE VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5567
Practice Address - Country:US
Practice Address - Phone:573-818-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012027907235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist