Provider Demographics
NPI:1154015667
Name:BJERGUM, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BJERGUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1987 MIDDLE CALMAR RD
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-7526
Mailing Address - Country:US
Mailing Address - Phone:563-277-2656
Mailing Address - Fax:
Practice Address - Street 1:1987 MIDDLE CALMAR RD
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-7526
Practice Address - Country:US
Practice Address - Phone:563-277-2656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer