Provider Demographics
NPI:1003905316
Name:BERGMANN, KRISTEN LYNN (LISW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LYNN
Last Name:BERGMANN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25000 CENTER RIDGE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4105
Mailing Address - Country:US
Mailing Address - Phone:440-343-6709
Mailing Address - Fax:
Practice Address - Street 1:25000 CENTER RIDGE RD STE 6
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4105
Practice Address - Country:US
Practice Address - Phone:440-343-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI87271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical