Individual
SUSAN DIANE BERGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LMFT
Contact information
Practice address
647 FILER AVE, TWIN FALLS, ID 83301-4008
(208) 737-9999
(208) 736-4400
Mailing address
225 LONG ISLAND AVE, TWIN FALLS, ID 83301-3096
(208) 735-1561
(208) 736-4400
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LMFT-2962
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010157599
REGENCE BLUE SHIELD
ID
Enumeration date
09/26/2006
Last updated
07/08/2007
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