Provider Demographics
NPI:1932324332
Name:BERTRAND, URSULA (PHD)
Entity Type:Individual
Prefix:DR
First Name:URSULA
Middle Name:
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E. WALNUT STREET
Mailing Address - Street 2:604
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301
Mailing Address - Country:US
Mailing Address - Phone:920-437-3854
Mailing Address - Fax:920-437-7488
Practice Address - Street 1:130 E. WALNUT STREET
Practice Address - Street 2:604
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301
Practice Address - Country:US
Practice Address - Phone:920-437-3854
Practice Address - Fax:920-437-7488
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1042103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling