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NPI Code Detail

MEDICARE: RAE JEAN BERGNER CSAC

MEDICARE: RAE JEAN BERGNER CSAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor16202WI

General Provider Information

NPI Number : 1770716771
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAE JEAN BERGNER CSAC
Provider Business Mailing Address
First Line : 1500 N 34TH ST STE 200
Second Line :
City : SUPERIOR
State : WI
Zip : 54880-4477
Country : US
Telephone Number : 715-395-5380
Fax Number : 715-394-2682
Provider Business Practice Location Address
First Line : 15954 RIVERS EDGE DR
Second Line :
City : HAYWARD
State : WI
Zip : 54843-7800
Country : US
Telephone Number : 715-634-2541
Fax Number : 715-394-2682
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2009
Last Update Date : 05/07/2021

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Directions to “ RAE JEAN BERGNER CSAC” Practice Location

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