Healthcare Provider Details

I. General information

NPI: 1992532782
Provider Name (Legal Business Name): BERGEN CAULFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5432 N HIGH ST
COLUMBUS OH
43214-1117
US

IV. Provider business mailing address

5432 N HIGH ST
COLUMBUS OH
43214-1117
US

V. Phone/Fax

Practice location:
  • Phone: 614-665-8878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2406056
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: