Provider Demographics
NPI:1770222648
Name:BERGIN, KATHERINE (AUD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BERGIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 ROCKLYN DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4935
Mailing Address - Country:US
Mailing Address - Phone:515-276-6122
Mailing Address - Fax:
Practice Address - Street 1:2328 ROCKLYN DR BLDG 3
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4935
Practice Address - Country:US
Practice Address - Phone:515-868-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA113952237700000X
IA114729231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist