Provider Demographics
NPI:1386406320
Name:BERGESON, SARAH ANNE (LPC, LCPC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:BERGESON
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 N SHADOW ROCK DR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-5600
Mailing Address - Country:US
Mailing Address - Phone:573-554-5470
Mailing Address - Fax:
Practice Address - Street 1:1544 N SHADOW ROCK DR
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-5600
Practice Address - Country:US
Practice Address - Phone:573-554-5470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022033962101YM0800X
KS04097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health