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General NPI Number Information
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NPI Number | 1043254006
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Entity Type | Individual
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Provider Name | JERICA BERGE PHD, LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | UMPHYSICIANS BROADWAY FAMILY MEDICINE 1020 WEST BROADWAY
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City | MINNEAPOLIS
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State | MN
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Zip | 55411
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Country | US
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Telephone | 612-302-8200
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Fax | 612-302-8275
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Provider Business Mailing Address
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Address Line | UMPHYSICIANS BROADWAY FAMILY MEDICINE 1020 WEST BROADWAY
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City | MINNEAPOLIS
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State | MN
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Zip | 55411
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Country | US
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Telephone | 612-302-8200
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Fax | 612-302-8275
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1218
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License Number State | MN
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