Provider Demographics
NPI:1346615655
Name:BERGDAHL, STEPHEN ALEXANDER (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALEXANDER
Last Name:BERGDAHL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S ASBURY ST STE 4A
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2243
Mailing Address - Country:US
Mailing Address - Phone:208-310-2266
Mailing Address - Fax:888-830-7441
Practice Address - Street 1:530 S ASBURY ST STE 4A
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2243
Practice Address - Country:US
Practice Address - Phone:208-310-2266
Practice Address - Fax:888-830-7441
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-203202103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical