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General NPI Number Information
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NPI Number | 1013727858
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Entity Type | Individual
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Provider Name | YVON BERGNER
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Gender | Male
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 26650 EUREKA RD STE A
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City | TAYLOR
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State | MI
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Zip | 48180-4835
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Country | US
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Telephone | 313-389-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 119 N HAMILTON ST APT 5
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City | YPSILANTI
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State | MI
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Zip | 48197-2987
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Country | US
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Telephone | 219-241-6579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6851119484
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License Number State | MI
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