Jasper Marlowe Berg, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY60732823 Issued in WA

Practice address

1200 5TH Ave Ste 800
Seattle, WA 98101-3136

Phone

(206) 374-0109

NPI assigned

Mar 9, 2015

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Joanna Margaret Berg Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 1, 2017 through Nov 1, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734912000000",
    "number": "1447643911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 5TH AVE STE 800",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981013136",
            "telephone_number": "206-374-0109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 5TH AVE STE 800",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981013136",
            "telephone_number": "206-374-0109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "JASPER",
        "middle_name": "MARLOWE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "U",
        "enumeration_date": "2015-03-09",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY60732823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOANNA",
            "last_name": "BERG",
            "middle_name": "MARGARET",
            "credential": "PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dorothy J Berg, PT
• Emily Berg
• Erika Caroline Berg
• Jacqueline Berg
• Janet M Berg, MD
• Joel Howard Berg, DDS
• John Anton Berg, RPH
• Kimberly Marie Berg, BA
• Rion Agar Berg, D.P.M.
• Roseann Leah Berg, D.C.

• Clinical Psychologist in Seattle, WA
• Providers in Seattle, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.