Individual
BRAELEE BERGON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
90 E 200 N, LOGAN, UT 84321-4034
(435) 752-0750
Mailing address
53 W 1150 N APT 2, LOGAN, UT 84341-6858
(801) 870-3225
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
12338791-3503
UT
Other
Enumeration date
06/30/2021
Last updated
06/30/2021
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