Provider Demographics
NPI:1447419544
Name:BERGMANN, BIRGIT KLAUDIA (CDP)
Entity Type:Individual
Prefix:MS
First Name:BIRGIT
Middle Name:KLAUDIA
Last Name:BERGMANN
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7017 NE HIGHWAY 99 STE 114
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0554
Mailing Address - Country:US
Mailing Address - Phone:360-694-7484
Mailing Address - Fax:360-694-7479
Practice Address - Street 1:7017 NE HIGHWAY 99 STE 114
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-0554
Practice Address - Country:US
Practice Address - Phone:360-694-7484
Practice Address - Fax:360-694-7479
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00003604174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP00003604OtherCHEMICAL DEPENDENCY PROFESSIONAL