Bergen, Susan Diane
Bergen, Susan Diane is an individual health care provider with primary practice located at 647 Filer Ave , Twin Falls ID 83301-4008. She recently has only one registered license in Behavioral Health & Social Service Providers / Marriage & Family Therapist, which is considered as her primary health care specialty. Bergen, Susan Diane can be contacted via phone (208) 737-9999.Contact Information
Primary practice address
647 Filer Ave
Twin Falls ID 83301-4008
Phone: (208) 737-9999
Fax: (208) 736-4400
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Marriage & Family Therapist | 106H00000X | LMFT-2962 | Idaho |
Profile Details
| NPI number | 1497856637 |
|---|---|
| LBN Legal business name | Bergen, Susan Diane |
| Credentials | MA, LMFT |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 26th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497856637 | NPPES |
| Idaho | Other | 000010157599 | REGENCE BLUE SHIELD |
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