Provider Demographics
NPI:1619201027
Name:COLLOVA-BERGEE, RENEE CATHERINE (LP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:CATHERINE
Last Name:COLLOVA-BERGEE
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8159 JAMACA AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-8348
Mailing Address - Country:US
Mailing Address - Phone:651-485-6229
Mailing Address - Fax:
Practice Address - Street 1:8159 JAMACA AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-8348
Practice Address - Country:US
Practice Address - Phone:651-485-6229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2833103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist