Provider Demographics
NPI:1508109166
Name:BERGGREN, JAYME ANN (APSW)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:ANN
Last Name:BERGGREN
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 W WEATHERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-6155
Mailing Address - Country:US
Mailing Address - Phone:262-352-2661
Mailing Address - Fax:414-257-3633
Practice Address - Street 1:1322 S 117TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-2127
Practice Address - Country:US
Practice Address - Phone:414-257-3622
Practice Address - Fax:414-257-3633
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI890-226101YP2500X
WI16308-130103TA0400X
WI128895-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)