Provider Demographics
NPI:1649655390
Name:BERTRAND, CALLIE (BS)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HALL AVE
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1655
Mailing Address - Country:US
Mailing Address - Phone:715-732-7793
Mailing Address - Fax:
Practice Address - Street 1:2500 HALL AVE
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1655
Practice Address - Country:US
Practice Address - Phone:715-732-7793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker