Provider Demographics
NPI:1104005438
Name:BARGSTEN, KERRY LEHAN
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:LEHAN
Last Name:BARGSTEN
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 1:3725 WESTWIND BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1099
Mailing Address - Country:US
Mailing Address - Phone:707-565-5909
Mailing Address - Fax:
Practice Address - Street 1:3725 WESTWIND BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1099
Practice Address - Country:US
Practice Address - Phone:707-565-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW138081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical