Provider Demographics
NPI:1275539124
Name:BERTSCHLER, JOHN (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BERTSCHLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 APPLE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3640
Mailing Address - Country:US
Mailing Address - Phone:440-262-3700
Mailing Address - Fax:440-262-3702
Practice Address - Street 1:1389 APPLE VALLEY CT
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-3640
Practice Address - Country:US
Practice Address - Phone:440-262-3700
Practice Address - Fax:440-262-3702
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4272103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0166047Medicaid
000000152019OtherANTHEM
OHP00112875OtherRAILROAD MEDICARE NUMBER
OH0166047Medicaid