Healthcare Provider Details

I. General information

NPI: 1760371843
Provider Name (Legal Business Name): BERG THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 ABERDEEN ST NE STE 120
BLAINE MN
55449-4811
US

IV. Provider business mailing address

15828 NORWAY ST NW
ANDOVER MN
55304-4353
US

V. Phone/Fax

Practice location:
  • Phone: 612-200-0704
  • Fax:
Mailing address:
  • Phone: 612-200-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA NAIBERG
Title or Position: CEO
Credential: MS, OTR/L
Phone: 612-200-0704