Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003420175 |
---|---|
Provider Name | Alexis Berg |
First Address | Fargo, ND 58104-8614 |
Second Address | Fargo, ND 58104-8614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2020 |
Last Update Date | 01/06/2021 |