Provider Demographics
NPI:1093413858
Name:BERG, REAGAN CHRISTINE DAY
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:CHRISTINE DAY
Last Name:BERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 NE ROSA PARKS WAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3657
Mailing Address - Country:US
Mailing Address - Phone:714-904-0256
Mailing Address - Fax:
Practice Address - Street 1:631 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4004
Practice Address - Country:US
Practice Address - Phone:971-256-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical