MEDICARE: LORI LYNN-BERG MCDIARMID LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6361005337	MI

General Provider Information

NPI Number	:	1326755356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI LYNN-BERG MCDIARMID LLP

Provider Business Mailing Address
First Line	:	300 68TH ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49548-6927
Country	:	US
Telephone Number	:	616-455-5000
Fax Number	:	616-281-6459

Provider Business Practice Location Address
First Line	:	17325 VAN WAGONER RD
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-9702
Country	:	US
Telephone Number	:	616-847-5145
Fax Number	:	616-847-4700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	01/07/2026

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