Basic Information
| Provider Information | |||||||||
| NPI: | 1972970465 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERGLAND | ||||||||
| FirstName: | SALLYE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 656 LYON ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941171308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002491266 | ||||||||
| FaxNumber: | 8003858191 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 E ORANGEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928056807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002491266 | ||||||||
| FaxNumber: | 8003858191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2015 | ||||||||
| LastUpdateDate: | 08/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-15-19015 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.