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General NPI Number Information
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NPI Number | 1639626294
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Entity Type | Individual
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Provider Name | KAI BERGONDI BLAKE M.ED
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Gender | Female
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 1919 15TH ST SE
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City | WASHINGTON
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State | DC
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Zip | 20020
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Country | US
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Telephone | 240-412-8260
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Fax |
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Provider Business Mailing Address
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Address Line | 7800 POMFRET RD
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City | POMFRET
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State | MD
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Zip | 20675-3218
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Country | US
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Telephone | 240-412-8260
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 10993888
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License Number State | DC
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