Provider Demographics
NPI:1033087853
Name:BERG, RILEY KENNETH
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:KENNETH
Last Name:BERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 BIELENBERG DR STE 180
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1736
Mailing Address - Country:US
Mailing Address - Phone:952-225-5467
Mailing Address - Fax:
Practice Address - Street 1:576 BIELENBERG DR STE 180
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1736
Practice Address - Country:US
Practice Address - Phone:952-225-5467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC3444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health