Individual
KERRI BERGQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
470 MAIN ST, MASHPEE, MA 02649-2047
(508) 760-1475
Mailing address
36 SANTUIT POND RD, MASHPEE, MA 02649-2421
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
—
—
103TS0200X
School Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FUW653A24076
BLUE CROSS BLUE SHIELD
MA
Enumeration date
03/31/2014
Last updated
03/31/2014
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