Individual
RICHARD BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
164 S 5TH ST, MONTPELIER, ID 83254-1557
(208) 847-4464
(208) 847-0980
Mailing address
971 MCKINLEY AVE, POCATELLO, ID 83201-4922
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW-26240
ID
Other
Enumeration date
04/06/2007
Last updated
07/09/2007
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