Provider Demographics
NPI:1356477921
Name:BERKA, LYNNETTE J
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:J
Last Name:BERKA
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 1:10333 LEVERMAN RD SE
Mailing Address - Street 2:
Mailing Address - City:AUMSVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97325-9407
Mailing Address - Country:US
Mailing Address - Phone:503-749-2166
Mailing Address - Fax:
Practice Address - Street 1:3180 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4532
Practice Address - Country:US
Practice Address - Phone:503-588-5351
Practice Address - Fax:503-585-4908
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator