Provider Demographics
NPI:1558245670
Name:BERGEN, AMELIA CLAIRE (LSW)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:CLAIRE
Last Name:BERGEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BERGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:1521 I ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2209
Mailing Address - Country:US
Mailing Address - Phone:720-237-1179
Mailing Address - Fax:
Practice Address - Street 1:109 BROOKDALE AVE STE F
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-8911
Practice Address - Country:US
Practice Address - Phone:720-357-0729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009924408104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker