Provider Demographics
NPI:1114225190
Name:BERGQUIST, SARA ELIZABETH (MT-BC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:BERGQUIST
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E INDIAN SCHOOL RD
Mailing Address - Street 2:3078
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1844
Mailing Address - Country:US
Mailing Address - Phone:970-443-5176
Mailing Address - Fax:
Practice Address - Street 1:411 E INDIAN SCHOOL RD
Practice Address - Street 2:3078
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1844
Practice Address - Country:US
Practice Address - Phone:970-443-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist