Individual
SAMANTHA BERGMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
8239 W HILLVIEW DR, MEQUON, WI 53097-3205
(402) 319-3770
Mailing address
8239 W HILLVIEW DR, MEQUON, WI 53097-3205
(402) 319-3770
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
84-140
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13608635
CAQH
WI
Enumeration date
06/04/2015
Last updated
01/10/2017
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