MEDICARE: MRS. HOLLY ANN BERTRAM

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	1041C0700X	Clinical Social Worker	103653	TX

General Provider Information

NPI Number	:	1679319917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY ANN BERTRAM

Provider Business Mailing Address
First Line	:	15414 CASCADE PT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-7110
Country	:	US
Telephone Number	:	830-469-9320
Fax Number	:

Provider Business Practice Location Address
First Line	:	15414 CASCADE PT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-7110
Country	:	US
Telephone Number	:	830-469-9320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	07/17/2024

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Directions to “ MRS. HOLLY ANN BERTRAM ” Practice Location

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