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General NPI Number Information
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NPI Number | 1669134946
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Entity Type | Individual
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Provider Name | MADDISON M BERG MA
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Gender | Female
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 1600 UNIVERSITY AVE W STE 12
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City | SAINT PAUL
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State | MN
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Zip | 55104-3952
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Country | US
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Telephone | 651-233-1481
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Fax |
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Provider Business Mailing Address
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Address Line | 3359 WARNER LN
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City | MOUND
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State | MN
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Zip | 55364-9261
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Country | US
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Telephone | 952-649-0461
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CC03575
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License Number State | MN
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