Provider Demographics
NPI:1518653922
Name:BERG, JANELLE KADLEC
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:KADLEC
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 1:17824 92ND ST SE
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT
Mailing Address - State:ND
Mailing Address - Zip Code:58030-9635
Mailing Address - Country:US
Mailing Address - Phone:701-474-5432
Mailing Address - Fax:
Practice Address - Street 1:17824 92ND ST SE
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT
Practice Address - State:ND
Practice Address - Zip Code:58030-9635
Practice Address - Country:US
Practice Address - Phone:701-474-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator