Individual
LAUREN A. BERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPA
Contact information
Practice address
1308 NW 20TH AVE, PORTLAND, OR 97209-1607
(503) 358-4122
(503) 977-2615
Mailing address
1308 NW 20TH AVE, PORTLAND, OR 97209-1607
(503) 358-4122
(503) 977-2615
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
5054
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CAQH# 11653362
CAQH
—
Enumeration date
01/26/2007
Last updated
07/08/2007
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