Basic Information
| Provider Information | |||||||||
| NPI: | 1689764516 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERGEY | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MA, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2931 E RIVER RD | ||||||||
| Address2: | P.O. BOX 1411 | ||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488589041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897731486 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 S CRAPO ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488582941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897725938 | ||||||||
| FaxNumber: | 9897757701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301007834 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.