MEDICARE: MRS. CORA BERGSTROM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor		CO

General Provider Information

NPI Number	:	1619435674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORA BERGSTROM

Provider Business Mailing Address
First Line	:	6586 CABANA CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3858
Country	:	US
Telephone Number	:	719-661-6451
Fax Number	:

Provider Business Practice Location Address
First Line	:	6586 CABANA CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3858
Country	:	US
Telephone Number	:	719-661-6451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2019
Last Update Date	:	12/30/2025

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Directions to “ MRS. CORA BERGSTROM ” Practice Location

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