Provider Demographics
NPI:1831507136
Name:BERRY, CECILIA L (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:L
Last Name:BERRY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10180 NICKOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-8063
Mailing Address - Country:US
Mailing Address - Phone:303-709-6899
Mailing Address - Fax:
Practice Address - Street 1:1027 TURNBERRY CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9594
Practice Address - Country:US
Practice Address - Phone:303-870-9302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1831507136Medicaid