Provider Demographics
NPI:1790978997
Name:BERGSTEDT, DAVID E (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:BERGSTEDT
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 98TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WIMBLEDON
Mailing Address - State:ND
Mailing Address - Zip Code:58492-9501
Mailing Address - Country:US
Mailing Address - Phone:701-435-2270
Mailing Address - Fax:
Practice Address - Street 1:1421 98TH AVE SE
Practice Address - Street 2:
Practice Address - City:WIMBLEDON
Practice Address - State:ND
Practice Address - Zip Code:58492-9501
Practice Address - Country:US
Practice Address - Phone:701-435-2270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND595235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist