Individual
CHASTITY BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
815 TRIPLETT STREET, OWENSBORO, KY 42302-1668
(270) 683-4517
Mailing address
815 TRIPLETT STREET, OWENSBORO, KY 42302-1668
(270) 683-4517
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4013
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
184517
MEDICARE
KY
05
—
45118379
—
KY
Enumeration date
10/11/2012
Last updated
10/11/2012
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