Individual
JACOB BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1409 CLARK ST, DES MOINES, IA 50314-1964
(515) 643-6500
Mailing address
310 NORTH BUXTON STREET, INDIANOLA, IA 50125
(515) 358-7608
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
083849
IA
Other
Enumeration date
03/15/2017
Last updated
03/15/2017
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