Healthcare Provider Details

I. General information

NPI: 1407070311
Provider Name (Legal Business Name): MICHELLE FRANCINE BERDAHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 05/22/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7723 SOUTH DELIVERY DRIVE
FRENCH CAMP CA
95236
US

IV. Provider business mailing address

500 W HOSPITAL RD
FRENCH CAMP CA
95231-9693
US

V. Phone/Fax

Practice location:
  • Phone: 94-686-8622
  • Fax: 209-468-6739
Mailing address:
  • Phone: 209-468-6862
  • Fax: 209-468-6739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: