| NPI | 1174144000 |
|---|---|
| Former Name | MELISSA KIERSTEN BERGSTROM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 120224) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 120224) |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2025-02-06 |