MEDICARE: ASHLEY BERG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2056	NE

General Provider Information

NPI Number	:	1154168995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY BERG

Provider Business Mailing Address
First Line	:	2535 COUNTRY CLUB AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-4220
Country	:	US
Telephone Number	:	515-298-0214
Fax Number	:

Provider Business Practice Location Address
First Line	:	2535 COUNTRY CLUB AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-4220
Country	:	US
Telephone Number	:	515-298-0214
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	07/10/2024

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Directions to “ ASHLEY BERG ” Practice Location

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