Provider Demographics
NPI:1053763235
Name:BERKENWALD, BIANCA BIMBATTI (AUD)
Entity type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:BIMBATTI
Last Name:BERKENWALD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:BIANCA
Other - Middle Name:
Other - Last Name:BIMBATTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:281 LINCOLN STREET
Mailing Address - Street 2:SUITE 253
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-334-8736
Mailing Address - Fax:
Practice Address - Street 1:281 LINCOLN STREET
Practice Address - Street 2:SUITE 253
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-334-8736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
MA1094231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist