Provider Demographics
NPI:1932140464
Name:BERGSTEN, MELANIE ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ANNE
Last Name:BERGSTEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 BIRTLES CT
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-8131
Mailing Address - Country:US
Mailing Address - Phone:614-961-2203
Mailing Address - Fax:
Practice Address - Street 1:1703 BIRTLES CT
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:OH
Practice Address - Zip Code:43021-8131
Practice Address - Country:US
Practice Address - Phone:614-961-2203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5883103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP67229Medicare UPIN