Provider Demographics
NPI:1811750250
Name:BERG, LAINE
Entity type:Individual
Prefix:
First Name:LAINE
Middle Name:
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 1:11211 DRANSFELDT RD STE 133
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9388
Mailing Address - Country:US
Mailing Address - Phone:303-841-8818
Mailing Address - Fax:303-841-5088
Practice Address - Street 1:11211 DRANSFELDT RD STE 133
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9388
Practice Address - Country:US
Practice Address - Phone:303-841-8818
Practice Address - Fax:303-841-5088
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHAD.0000529237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist