Provider Demographics
NPI:1932384997
Name:BERGSTROM, CHRISTEN TROY
Entity Type:Individual
Prefix:MRS
First Name:CHRISTEN
Middle Name:TROY
Last Name:BERGSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5257
Mailing Address - Country:US
Mailing Address - Phone:931-542-2168
Mailing Address - Fax:931-542-2206
Practice Address - Street 1:851 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:931-542-2168
Practice Address - Fax:931-542-2168
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.000739235Z00000X
TN0000005364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist