MEDICARE: MS. BARBARA HEIDI BERGSTRASSER

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1821321498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA HEIDI BERGSTRASSER

Provider Business Mailing Address
First Line	:	PO BOX 35101
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87176-5101
Country	:	US
Telephone Number	:	505-881-8982
Fax Number	:	505-872-0392

Provider Business Practice Location Address
First Line	:	5301 PONDEROSA AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1216
Country	:	US
Telephone Number	:	505-881-8982
Fax Number	:	505-872-0392

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

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	09/14/2009

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