Provider Demographics
NPI:1134779937
Name:BERGMAN, LEANNE (RBAI)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:RBAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 SW HAMPTON ST STE 310
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8332
Mailing Address - Country:US
Mailing Address - Phone:971-200-5030
Mailing Address - Fax:
Practice Address - Street 1:6950 SW HAMPTON ST STE 310
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8332
Practice Address - Country:US
Practice Address - Phone:971-200-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-IN-10184574106S00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician