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General NPI Number Information
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NPI Number | 1972835601
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Entity Type | Individual
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Provider Name | TAMARA E BERGUM MFT
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Gender | Female
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Dates
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Enumeration Date | 02/05/2010
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Last Update Date | 02/05/2010
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Provider Practice Location Address
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Address Line | 15655 W COUNTY ROAD B
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City | HAYWARD
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State | WI
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Zip | 54843-3251
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Country | US
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Telephone | 715-634-0607
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Fax | 715-634-0617
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Provider Business Mailing Address
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Address Line | 15655 W COUNTY ROAD B P.O. BOX 13251
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City | HAYWARD
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State | WI
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Zip | 54843-2680
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Country | US
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Telephone | 715-634-0607
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Fax | 715-634-0617
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 141-228
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License Number State | WI
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