Provider Demographics
NPI:1033438619
Name:BERGESON, GAIL PILCH (BA)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:PILCH
Last Name:BERGESON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-2372
Mailing Address - Country:US
Mailing Address - Phone:608-477-9858
Mailing Address - Fax:608-742-3636
Practice Address - Street 1:708 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-2372
Practice Address - Country:US
Practice Address - Phone:608-477-9858
Practice Address - Fax:608-742-3636
Is Sole Proprietor?:No
Enumeration Date:2010-05-22
Last Update Date:2010-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker