Jennifer Eileen Bergstrom, SLP-CCC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA10370 Issued in FL

Practice address

6100 Griffin Rd
Davie, FL 33314-4416

Phone

(954) 262-7783

NPI assigned

Jun 23, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Jennifer Eileen O'Brien Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jennifer.bergstrom.p1@direct.salusuhealth.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nova Southeastern University, Inc

  • Family Medicine Physician
  • Davie, FL
  • NPI 1447345517
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1982865895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290370",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333290370",
            "telephone_number": "954-262-4346",
            "fax_number": "954-262-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 GRIFFIN RD",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333144416",
            "telephone_number": "954-262-7783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGSTROM",
        "first_name": "JENNIFER",
        "middle_name": "EILEEN",
        "name_prefix": "Ms.",
        "credential": "SLP-CCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-23",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2008016599",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA10370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "O'BRIEN",
            "middle_name": "EILEEN",
            "prefix": "MRS.",
            "credential": "M.S., CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Camille Zampino Bentley, D.O.
• Ramon Alberto Berenguer, M.D.
• Tiana Tamara Berezu, O.D.
• Stephen Franklyn Berger, D.D.S.
• Martina Berghmans
• Tsakaia Berkeley, OTR/L
• Judith Bermeo
• Adriana Bermudez
• Andrea Patricia Bermudez
• Tatiannah Bernard

• Speech-Language Pathologist in Davie, FL
• Providers in Davie, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.