Provider Demographics
NPI:1770272809
Name:BERG, CANDICE KIMBERLY (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:KIMBERLY
Last Name:BERG
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8765 MERRITT PL
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN IRON
Mailing Address - State:MN
Mailing Address - Zip Code:55768-2016
Mailing Address - Country:US
Mailing Address - Phone:218-969-9362
Mailing Address - Fax:
Practice Address - Street 1:2900 E BELTLINE STE 16
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2345
Practice Address - Country:US
Practice Address - Phone:218-969-9362
Practice Address - Fax:218-263-6789
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN289631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical