Provider Demographics
NPI:1295160216
Name:BERGMANN, KELLY L (RBT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:BERGMANN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MCCALLIE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2927
Mailing Address - Country:US
Mailing Address - Phone:423-531-6961
Mailing Address - Fax:423-521-8094
Practice Address - Street 1:1400 MCCALLIE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2927
Practice Address - Country:US
Practice Address - Phone:423-531-6961
Practice Address - Fax:423-521-8094
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator