Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 890-226 | WI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 16308-130 | WI |
Y | 104100000X | Social Worker | 128895-121 | WI |
NPI | 1508109166 |
---|---|
Provider Name | Jayme Ann Berggren |
First Address | New Berlin, WI 53151-6155 |
Second Address | West Allis, WI 53214-2127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2013 |
Last Update Date | 05/04/2013 |