Provider Demographics
NPI:1467240416
Name:BERG, CAYLEN NICOLE
Entity type:Individual
Prefix:
First Name:CAYLEN
Middle Name:NICOLE
Last Name:BERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 UPTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-1366
Mailing Address - Country:US
Mailing Address - Phone:262-442-9471
Mailing Address - Fax:
Practice Address - Street 1:N14W23800 STONE RIDGE DR STE 110
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1144
Practice Address - Country:US
Practice Address - Phone:262-696-5325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN528846235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist