MEDICARE: BERENDZEN MENTAL HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1235871120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERENDZEN MENTAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	2300 CLAY ST
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-4044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6315 CHANCELLOR DR STE 3
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-6919
Country	:	US
Telephone Number	:	319-281-0179
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNA BEREBDZEN
Credential	:
Telephone Number	:	319-281-0179

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	04/11/2022

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