Healthcare Provider Details

I. General information

NPI: 1114849270
Provider Name (Legal Business Name): JADE BERG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 WHITEWATER DR
HOPKINS MN
55343-8491
US

IV. Provider business mailing address

1425 MINNEHAHA AVE E UNIT 600321
SAINT PAUL MN
55106-4892
US

V. Phone/Fax

Practice location:
  • Phone: 651-313-8080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: