Active NPI
Gwendolyn Louise Bergman
- Behavior Analyst
- Fort Recovery, OH
National Provider Identifier
1265847958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- OH3128822
- Practice address
- 117 E Broadway St Lot 49
Fort Recovery, OH 45846-9318 - Phone
- (419) 953-1789
- NPI assigned
- Jun 22, 2014
- Last updated
- Jun 22, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | OH3128822 | OH | Primary |
Addresses
Primary practice location
117 E Broadway St Lot 49
Fort Recovery, OH 45846-9318
Mailing address
117 East Broadway St. Lot 49
Fort, OH 45846
Phone (419) 953-1789
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OH3128822 | OH | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403395200000",
"number": "1265847958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 EAST BROADWAY ST. LOT 49",
"city": "FORT",
"state": "OH",
"postal_code": "45846",
"telephone_number": "419-953-1789"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 E BROADWAY ST LOT 49",
"city": "FORT RECOVERY",
"state": "OH",
"postal_code": "458469318",
"telephone_number": "419-953-1789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGMAN",
"first_name": "GWENDOLYN",
"middle_name": "LOUISE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-22",
"last_updated": "2014-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "OH",
"license": "OH3128822",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Recovery, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.