Provider Demographics
NPI:1467605824
Name:BERGE, EMILY K (LPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:K
Last Name:BERGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 BRACKETT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4626
Mailing Address - Country:US
Mailing Address - Phone:715-864-6386
Mailing Address - Fax:715-514-2116
Practice Address - Street 1:1738 BRACKETT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4626
Practice Address - Country:US
Practice Address - Phone:715-864-6386
Practice Address - Fax:715-514-2116
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4108-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42245100Medicaid