Individual
JORDAN LEIGH BERGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
1753 FULTON ST, ELKHART, IN 46514-1927
(574) 293-9448
(574) 293-9480
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
23002688A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300027641
—
IN
Enumeration date
06/20/2019
Last updated
03/30/2021
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