Individual
GWENDOLYN LOUISE BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
117 E BROADWAY ST LOT 49, FORT RECOVERY, OH 45846-9318
(419) 953-1789
Mailing address
117 EAST BROADWAY ST. LOT 49, FORT, OH 45846
(419) 953-1789
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
OH3128822
OH
Other
Enumeration date
06/22/2014
Last updated
06/22/2014
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