Provider Demographics
NPI:1407070311
Name:BERDAHL, MICHELLE FRANCINE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FRANCINE
Last Name:BERDAHL
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 1:500 W HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231-9693
Mailing Address - Country:US
Mailing Address - Phone:209-468-6862
Mailing Address - Fax:209-468-6739
Practice Address - Street 1:7723 SOUTH DELIVERY DRIVE
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95236
Practice Address - Country:US
Practice Address - Phone:094-686-8622
Practice Address - Fax:209-468-6739
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)