Bergstrom, Jordan Leigh
Bergstrom, Jordan Leigh is an individual health care provider with primary practice located at 1753 Fulton St , Elkhart IN 46514-1927. She recently has only one registered license in Speech, Language and Hearing Service Providers / Audiologist, which is considered as her primary health care specialty. Bergstrom, Jordan Leigh can be contacted via phone (574) 293-9448.Contact Information
Primary practice address
1753 Fulton St
Elkhart IN 46514-1927
Phone: (574) 293-9448
Fax: (574) 293-9480
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Audiologist | 231H00000X | 23002688A | Indiana |
Profile Details
| NPI number | 1750941779 |
|---|---|
| LBN Legal business name | Bergstrom, Jordan Leigh |
| Credentials | AU.D. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 20th, 2019 |
| Last updated | Mar 30th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1750941779 | NPPES |
| Indiana | MEDICAID | 300027641 |
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