Provider Demographics
NPI:1093775462
Name:BERGMAN, DAWN C (LPC)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:C
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:C
Other - Last Name:SOKOLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:14377 WOODLAKE DR
Mailing Address - Street 2:STE 308
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-576-6493
Mailing Address - Fax:314-576-7319
Practice Address - Street 1:14377 WOODLAKE DR
Practice Address - Street 2:STE 308
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-576-6493
Practice Address - Fax:314-576-7319
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002009342101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor