| Doctor Name: | JENNIFER EILEEN BERGSTROM |
| NPI Number: | 1982865895 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SLP-CCC |
| License Number: | 2008016599 |
| Business Practice Address: | 121 Heather Ln Parrish, FL - 342198912 |
| Business Phone Number: | 9545519654 |
| Business Fax Number: | |
| Mailing Address: | Po Box 290370, FT LAUDERDALE |
| State: | FL |
| Postal Code: | 333290370 |
| Phone Number: | 9542624346 |
| Fax Number: | 9542622269 |
| NPI Enumeration Date: | 06/23/2008 |
| NPI Last Update Date: | 05/16/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2008016599 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |