Healthcare Provider Details

I. General information

NPI: 1841663812
Provider Name (Legal Business Name): ALEXANDRA L BERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 N WILSON AVE
LOVELAND CO
80537-4461
US

IV. Provider business mailing address

125 CRESTRIDGE ST
FORT COLLINS CO
80525-3934
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-9870
  • Fax:
Mailing address:
  • Phone: 970-494-9761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: