Healthcare Provider Details

I. General information

NPI: 1750501672
Provider Name (Legal Business Name): SUSAN STILL BERGMAN MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 MARGARET ANN AVE
BATON ROUGE LA
70809-3444
US

IV. Provider business mailing address

213 S CARROLLTON AVE
BATON ROUGE LA
70806-4404
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-6041
  • Fax:
Mailing address:
  • Phone: 225-925-8784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: