Provider Demographics
NPI:1770832289
Name:BERGMANN, DANIELLE ALISE (MS)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ALISE
Last Name:BERGMANN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E CODA CIR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-3563
Mailing Address - Country:US
Mailing Address - Phone:954-249-3712
Mailing Address - Fax:
Practice Address - Street 1:105 E CODA CIR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-3563
Practice Address - Country:US
Practice Address - Phone:954-249-3712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5898235Z00000X
FLSA12512235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist