Healthcare Provider Details

I. General information

NPI: 1578491221
Provider Name (Legal Business Name): HAILEY BERGQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 POND ST
FRANKLIN MA
02038-3807
US

IV. Provider business mailing address

39 COUNTY ST
LAKEVILLE MA
02347-1809
US

V. Phone/Fax

Practice location:
  • Phone: 508-528-6037
  • Fax:
Mailing address:
  • Phone: 774-766-9094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: