Provider Demographics
NPI:1851731251
Name:BERGER, LANDON (PSYD)
Entity Type:Individual
Prefix:
First Name:LANDON
Middle Name:
Last Name:BERGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 NW IRVING ST APT 8
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3392
Mailing Address - Country:US
Mailing Address - Phone:503-209-9218
Mailing Address - Fax:503-372-5843
Practice Address - Street 1:6125 NE CORNELL RD STE 290
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5417
Practice Address - Country:US
Practice Address - Phone:503-389-5473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2255103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR9049971OtherDRIVERS LICENSE