Pam Bergman

Individual provider Active NPI Clinical Psychologist · Raymore, MO

NPI 1942681747 · NPPES record last updated Jun 17, 2015

Key facts

NPI
1942681747
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Psychologist 103TC0700X
License
431032835 (MO)
Practice address
1010 Remmington
Pathways
Raymore, MO 66401
Phone
(816) 318-4430
NPI assigned
Jun 17, 2015
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

LicenseStateTypeSpecialty
431032835MOMDFamily Psychologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 431032835 MO Yes
Family Psychologist 103TF0000X 431032835 MO

Addresses

Primary practice location

1010 Remmington
Pathways
Raymore, MO 66401

Mailing address

1010 Remmington
Pathways
Raymore, MO 66401
Phone (816) 318-4430

Other providers in Raymore, MO

All providers in Raymore, MO · Clinical Psychologist in Missouri

Sources for this page

Verify at the official NPI Registry.