| Doctor Name: | MR. BRADLEY J BERGESON |
| NPI Number: | 1205052420 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MED, LMHP, LADC |
| License Number: | 608 |
| Business Practice Address: | 917 W 21st St South Sioux City, NE - 687762652 |
| Business Phone Number: | 4024943337 |
| Business Fax Number: | 4024943356 |
| Mailing Address: | 1008 S Saint Marys St, SIOUX CITY |
| State: | IA |
| Postal Code: | 511061357 |
| Phone Number: | 7122761299 |
| Fax Number: | 7122761299 |
| NPI Enumeration Date: | 04/17/2007 |
| NPI Last Update Date: | 04/26/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 608 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NE |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |