Provider Demographics
NPI:1124081344
Name:BERGEN, LINDA LEE (ATC NATA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:BERGEN
Suffix:
Gender:F
Credentials:ATC NATA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 IOWA HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9584
Mailing Address - Country:US
Mailing Address - Phone:360-595-2278
Mailing Address - Fax:
Practice Address - Street 1:820 IOWA HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-9584
Practice Address - Country:US
Practice Address - Phone:360-595-2278
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer