Gwendolyn Louise Bergman
Individual provider Active NPI Behavior Analyst · Fort Recovery, OH
NPI 1265847958 · NPPES record last updated Jun 22, 2014
Key facts
- NPI
- 1265847958
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- OH3128822 (OH)
- Practice address
- 117 E Broadway St Lot 49
Fort Recovery, OH 45846-9318 - Phone
- (419) 953-1789
- NPI assigned
- Jun 22, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OH3128822 | OH | MD | Behavioral Analyst |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | OH3128822 | OH | Yes |
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
Other providers in Fort Recovery, OH
- Adam Alig
- Amy Wendel Family Health, LLC
- Jenelle Backs
- Jennifer Renee Basford
- Maggie Bollenbacher
- Jacquelyn Lee Briscoe
- Lauren Elizabeth Broering
- Erin Heather Burns
- Carr Corporation
All providers in Fort Recovery, OH · Behavior Analyst in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.