Provider Demographics
NPI:1619658390
Name:BERGMANN, NOELLE DENAE (SUDPT)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:DENAE
Last Name:BERGMANN
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 BONITA LN
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-8187
Mailing Address - Country:US
Mailing Address - Phone:360-550-7198
Mailing Address - Fax:
Practice Address - Street 1:390 E CEDAR ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3403
Practice Address - Country:US
Practice Address - Phone:360-681-8463
Practice Address - Fax:360-681-8465
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61456865101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)