Provider Demographics
NPI:1043254006
Name:BERGE, JERICA (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:JERICA
Middle Name:
Last Name:BERGE
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UMPHYSICIANS BROADWAY FAMILY MEDICINE
Mailing Address - Street 2:1020 WEST BROADWAY
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411
Mailing Address - Country:US
Mailing Address - Phone:612-302-8200
Mailing Address - Fax:612-302-8275
Practice Address - Street 1:UMPHYSICIANS BROADWAY FAMILY MEDICINE
Practice Address - Street 2:1020 WEST BROADWAY
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411
Practice Address - Country:US
Practice Address - Phone:612-302-8200
Practice Address - Fax:612-302-8275
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1218106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40992300Medicaid
MN62-66860OtherUBH
MN1044097OtherPREFERRED ONE
MN136417OtherUCARE
MNHP37859OtherHEALTHPARTNERS