Provider Demographics
NPI:1750501672
Name:BERGMAN, SUSAN STILL (MT-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:STILL
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4404
Mailing Address - Country:US
Mailing Address - Phone:225-925-8784
Mailing Address - Fax:
Practice Address - Street 1:8080 MARGARET ANN AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3444
Practice Address - Country:US
Practice Address - Phone:225-765-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist