Healthcare Provider Details

I. General information

NPI: 1801766670
Provider Name (Legal Business Name): FAITH BERGMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 WALNUT ST UNIT 614
CINCINNATI OH
45202-3991
US

IV. Provider business mailing address

414 WALNUT ST UNIT 614
CINCINNATI OH
45202-3991
US

V. Phone/Fax

Practice location:
  • Phone: 773-701-0882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License NumberLD.11053
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.11053
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: