Provider Demographics
NPI:1902696156
Name:BERGGREN, EZRI RENEE
Entity type:Individual
Prefix:
First Name:EZRI
Middle Name:RENEE
Last Name:BERGGREN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10411 SW BRIDGET ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-8708
Mailing Address - Country:US
Mailing Address - Phone:316-765-4951
Mailing Address - Fax:
Practice Address - Street 1:3600 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5819
Practice Address - Country:US
Practice Address - Phone:830-896-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist