Healthcare Provider Details

I. General information

NPI: 1750873048
Provider Name (Legal Business Name): CIARA BERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 HIGHWAY 7
ST LOUIS PARK MN
55426-4223
US

IV. Provider business mailing address

311 11TH AVENUE CT SE
ISANTI MN
55040-4576
US

V. Phone/Fax

Practice location:
  • Phone: 952-814-0207
  • Fax:
Mailing address:
  • Phone: 763-245-6030
  • Fax: 651-982-6035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: