Provider Demographics
NPI:1700942125
Name:BERGMANN, CAROL ELAINE (AUD,CCC-A)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ELAINE
Last Name:BERGMANN
Suffix:
Gender:F
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15825 MANCHESTER RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2263
Mailing Address - Country:US
Mailing Address - Phone:636-391-9622
Mailing Address - Fax:636-391-9236
Practice Address - Street 1:15825 MANCHESTER RD
Practice Address - Street 2:SUITE 209
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2263
Practice Address - Country:US
Practice Address - Phone:636-391-9622
Practice Address - Fax:636-391-9236
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00695237600000X
MO01404231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO640004344OtherRAILFROAD MEDICARE
MO431795961HEAOtherMERCY HEALTH PLAN
MO46131OtherHEALTHCARE USA
MO407251OtherHEALTHLINK
7473310OtherAETNA
MO141099800OtherDEPARTMENT OF LABOR
MO431795961OtherPLUMBERS & PIPEFITTERS
4500105OtherUNITED HEALTHCARE
MO126804OtherBLUE CROSS BLUE SHIELD
MO333890101Medicaid
4500105OtherUNITED HEALTHCARE
431795961Medicare UPIN