Healthcare Provider Details

I. General information

NPI: 1326261793
Provider Name (Legal Business Name): DAVID WILLARD BERGSMA M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 LAKE DR SE
GRAND RAPIDS MI
49506-1674
US

IV. Provider business mailing address

1923 MOERLAND CT NW
GRAND RAPIDS MI
49504-2319
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-7215
  • Fax: 616-451-0020
Mailing address:
  • Phone: 616-901-4304
  • Fax: 616-451-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: