Provider Demographics
NPI:1932217015
Name:BERGLUND, EILEEN MARY (DC, LPC-IT)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:MARY
Last Name:BERGLUND
Suffix:
Gender:F
Credentials:DC, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 OLD GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53403-9425
Mailing Address - Country:US
Mailing Address - Phone:262-417-6066
Mailing Address - Fax:
Practice Address - Street 1:5027 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1771
Practice Address - Country:US
Practice Address - Phone:262-925-8600
Practice Address - Fax:262-925-8599
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2811111N00000X
WI7401-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU27548Medicare UPIN