Individual
MRS. REGINA RAE BERGMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1707 S 46TH ST, QUINCY, IL 62305-9058
(217) 224-4581
Mailing address
1707 S 46TH ST, QUINCY, IL 62305-9058
(217) 224-4581
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
08/31/2011
Last updated
08/31/2011
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