Provider Demographics
NPI:1740465152
Name:BERGAN, CYNTHIA (MA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BERGAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:830-275-4216
Mailing Address - Fax:512-858-2714
Practice Address - Street 1:3443 N CAMPBELL AVE STE 135
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719
Practice Address - Country:US
Practice Address - Phone:520-202-6008
Practice Address - Fax:520-547-2065
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ191778OtherMEDICARE
AZZ191776OtherMEDICARE
AZZ191777OtherMEDICARE