Individual
KELLY BERGMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
625 W ELM AVE, HANOVER, PA 17331-5125
(717) 632-4900
(717) 632-4313
Mailing address
625 W ELM AVE, HANOVER, PA 17331-5125
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH001729
PA
Other
Enumeration date
09/04/2014
Last updated
09/04/2014
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