Provider Demographics
NPI:1982229001
Name:BERG, CASSIDY ELLEN (MD, RD)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:ELLEN
Last Name:BERG
Suffix:
Gender:F
Credentials:MD, RD
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:ELLEN
Other - Last Name:SLOOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:580 RICE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-2148
Mailing Address - Country:US
Mailing Address - Phone:651-227-6551
Mailing Address - Fax:
Practice Address - Street 1:580 RICE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-2148
Practice Address - Country:US
Practice Address - Phone:651-227-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN86052315OtherCOMMISSION ON DIETETIC REGISTRATION