Provider Demographics
NPI:1235527052
Name:BERGQUIST, ROGENE L TWEETEN (MSSW)
Entity Type:Individual
Prefix:
First Name:ROGENE
Middle Name:L TWEETEN
Last Name:BERGQUIST
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 YUKON AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-2420
Mailing Address - Country:US
Mailing Address - Phone:612-281-9527
Mailing Address - Fax:
Practice Address - Street 1:2501 YUKON AVE S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-2420
Practice Address - Country:US
Practice Address - Phone:612-281-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN077251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical