Individual
KEVIN R BERGERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDPT
Contact information
Practice address
1703 DOUGLAS CT, MILTON, WA 98354-9727
(360) 888-7087
Mailing address
500 SE WASHINGTON AVE, CHEHALIS, WA 98532-3058
(360) 748-4776
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO61275243
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2077844
—
WA
Enumeration date
04/06/2022
Last updated
08/13/2024
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