Provider Demographics
NPI:1033669718
Name:BERGSTROM, KATIE LEE (MS, CGC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LEE
Last Name:BERGSTROM
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:M/S MB.8.501 PO BOX 5371
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5005
Mailing Address - Country:US
Mailing Address - Phone:206-987-1543
Mailing Address - Fax:206-985-3357
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-1543
Practice Address - Fax:206-985-3357
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS