| Doctor Name: | AMY BERG |
| NPI Number: | 1205204799 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PMHNP |
| License Number: | 201506290NP-PP |
| Business Practice Address: | 125 Sw C St Madras, OR - 977411458 |
| Business Phone Number: | 5414756575 |
| Business Fax Number: | |
| Mailing Address: | 1008 N Bryant St, PORTLAND |
| State: | OR |
| Postal Code: | 972171600 |
| Phone Number: | 5035502374 |
| Fax Number: | |
| NPI Enumeration Date: | 09/14/2015 |
| NPI Last Update Date: | 09/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 201506290NP-PP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |