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Individual

TAMARA E BERGUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MFT

Contact information

Practice address
15655 W COUNTY ROAD B, HAYWARD, WI 54843-3251
(715) 634-0607
(715) 634-0617
Mailing address
15655 W COUNTY ROAD B, P.O. BOX 13251, HAYWARD, WI 54843-2680
(715) 634-0607
(715) 634-0617

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
141-228
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
141-228
WI DRL
WI
Enumeration date
02/05/2010
Last updated
02/05/2010
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