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Individual

MRS. ANGELIC BERRY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.ED, M.S.

Contact information

Practice address
4732 PATRIOTS DR, SCOTT AFB, IL 62225-1197
(618) 746-4738
Mailing address
4732 PATRIOTS DR, SCOTT AFB, IL 62225-1197
(618) 746-4738

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.010486
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
934010
ILLINOIS STATE BOARD OF EDUCATION
IL
Enumeration date
12/20/2013
Last updated
12/20/2013
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