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General NPI Number Information
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NPI Number | 1093223372
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Entity Type | Individual
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Provider Name | JENNIFER BERG
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Gender | Female
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Dates
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Enumeration Date | 01/20/2018
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Last Update Date | 01/20/2018
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Provider Practice Location Address
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Address Line | 137 S 17TH ST APT B
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City | ST CHARLES
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State | IL
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Zip | 60174-2547
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Country | US
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Telephone | 815-505-3535
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Fax |
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Provider Business Mailing Address
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Address Line | 137 S 17TH ST APT B
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City | ST CHARLES
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State | IL
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Zip | 60174-2547
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Country | US
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Telephone |
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Fax |
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | IL
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