Individual
MRS. PENELOPE BERGERON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
315 S 100 E, PROVO, UT 84606-4649
(801) 318-7037
Mailing address
5612 W 10930 N, HIGHLAND, UT 84003-8897
(801) 318-7037
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7005879-3501
UT
Other
Enumeration date
01/29/2016
Last updated
01/29/2016
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