Provider Demographics
NPI:1316496623
Name:BERKOWSKI, CHARYSSE LEIGH
Entity type:Individual
Prefix:MS
First Name:CHARYSSE
Middle Name:LEIGH
Last Name:BERKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GRAND CENTRAL LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-1302
Mailing Address - Country:US
Mailing Address - Phone:847-891-3745
Mailing Address - Fax:
Practice Address - Street 1:2 GRAND CENTRAL LN
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-1302
Practice Address - Country:US
Practice Address - Phone:847-891-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer