Individual
BERGEN D RUSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11175 S REDWOOD RD, SOUTH JORDAN, UT 84095-8208
(801) 359-4600
Mailing address
11175 S REDWOOD RD, SOUTH JORDAN, UT 84095-8208
(801) 359-4600
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
11046853-4002
UT
Other
Enumeration date
03/24/2019
Last updated
03/24/2019
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