Individual
LAURA KAY BERGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
(503) 267-4096
Mailing address
1333 10TH ST, WEST LINN, OR 97068-4626
(503) 583-4497
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
11565
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11565
STATE SLP LICENSE
OR
Enumeration date
04/26/2019
Last updated
04/26/2019
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