Provider Demographics
NPI:1912728791
Name:BERKHOF, GRETA MARIE
Entity type:Individual
Prefix:
First Name:GRETA
Middle Name:MARIE
Last Name:BERKHOF
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 1:725 N 13TH ST RM 320
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2208
Mailing Address - Country:US
Mailing Address - Phone:312-550-6578
Mailing Address - Fax:
Practice Address - Street 1:525 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-2703
Practice Address - Country:US
Practice Address - Phone:414-288-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician