Provider Demographics
NPI:1659186708
Name:BERG, COLYN (MSW, APSW, SAC-IT)
Entity type:Individual
Prefix:
First Name:COLYN
Middle Name:
Last Name:BERG
Suffix:
Gender:M
Credentials:MSW, APSW, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E OLSON ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:WI
Mailing Address - Zip Code:54616-9307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 5TH AVE S STE 508
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4059
Practice Address - Country:US
Practice Address - Phone:608-387-9638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20459-130101YA0400X
MI6851119332104100000X
WI17013-137405300000X
WI135215-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No405300000XOther Service ProvidersPrevention Professional