Provider Demographics
NPI:1447643911
Name:BERG, JASPER MARLOWE (PHD)
Entity type:Individual
Prefix:DR
First Name:JASPER
Middle Name:MARLOWE
Last Name:BERG
Suffix:
Gender:U
Credentials:PHD
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:MARGARET
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1200 5TH AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3136
Mailing Address - Country:US
Mailing Address - Phone:206-374-0109
Mailing Address - Fax:
Practice Address - Street 1:1200 5TH AVE STE 800
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3136
Practice Address - Country:US
Practice Address - Phone:206-374-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60732823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical