Provider Demographics
NPI:1881269900
Name:BERGMAN, COURTNEY ELOISE (MS CF-SLP, PCBIS)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ELOISE
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:MS CF-SLP, PCBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 E 171ST ST S
Mailing Address - Street 2:
Mailing Address - City:MOUNDS
Mailing Address - State:OK
Mailing Address - Zip Code:74047
Mailing Address - Country:US
Mailing Address - Phone:918-625-3666
Mailing Address - Fax:
Practice Address - Street 1:429 W WILSHIRE BLVD, STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116
Practice Address - Country:US
Practice Address - Phone:405-250-3071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCF308235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist