RUSSELL BERGTOLD (NPI# 1982266698) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982266698 |
| Entity Type | Individual |
| Full Name | RUSSELL BERGTOLD |
| Practice Address |
1909 Cheker Sq East Hazel Crest IL 60429-1442 |
| Practice Telephone | 7086473333 |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2019-07-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
IL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NA | NA | 01 |
| Street Address |
1909 CHEKER SQ |
| City | EAST HAZEL CREST |
| State | IL |
| Zip Code | 60429-1442 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558362863 | South Suburban Council On Alcoholism and Substance Abuse | Substance Abuse Rehabilitation Facility | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2005-08-09 |
| 1003416298 | Jasmine Carter | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2020-10-28 |
| 1619509692 | Joseph Siegert | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2020-02-07 |
| 1811533847 | Adejumoke Alimi | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2019-11-25 |
| 1316581309 | Cierra Cook | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2019-11-01 |
| 1356993950 | Anita Mcclain | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2019-07-12 |
| 1104482223 | Marne Chelsea Egarton | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2019-05-14 |
| 1841856077 | George Robert Carter Jr. | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2019-05-13 |
| 1730742446 | Derrick Bruce | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2019-04-18 |
| 1669931671 | Asia Bey | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2019-03-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659917987 | Nancy Sinwelski | Technician | 17305 Fisk Street, East Hazelcrest, IL 60429 | 2019-11-21 |
| 1144720871 | Plentiful Hair Studio LLC | Specialist | 17504 E Carriageway Dr Ste D, Hazel Crest, IL 60429 | 2018-02-19 |
| 1376052142 | Natalie Allen | Counselor | 3518 Birchwood Dr, Hazel Crest, IL 60429 | 2017-09-25 |
| 1730534009 | Lydena Franklin | Counselor | 1909 Cheker Square, East Hazel Crest, IL 60429 | 2016-04-25 |
| 1710331053 | Lauiren Orta | Counselor | 1901 Cheker Square, E Hazel Crest, IL 60429 | 2016-04-22 |
| 1427423367 | Andrea Leigh Warren | Nurse Practitioner | 17800 S. Kedzie Ave, Hazel Crest, IL 60429 | 2015-12-03 |
| 1770969354 | Karriem's Developmental Services | Day Training, Developmentally Disabled Services | 18513 River Road, Hazel Crest, IL 60429 | 2015-08-05 |
| 1073905170 | James Kamper | Physical Therapy Assistant | 1816 W 170th Street, Hazel Crest, IL 60429 | 2015-02-26 |
| 1194066019 | Marilyn C Scott | Psychologist | 18505 Meadow Ln., Hazel Crest, IL 60429 | 2013-03-04 |
| 1649548405 | Supported Independence | Community/Behavioral Health | 17009 Elm Drive, Hazel Crest, IL 60429 | 2011-12-08 |
| Find all providers in zip 60429 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730534009 | Lydena Franklin | Counselor | 1909 Cheker Square, East Hazel Crest, IL 60429 | 2016-04-25 |
| 1003416298 | Jasmine Carter | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2020-10-28 |
| 1619509692 | Joseph Siegert | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2020-02-07 |
| 1811533847 | Adejumoke Alimi | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2019-11-25 |
| 1316581309 | Cierra Cook | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2019-11-01 |
| 1356993950 | Anita Mcclain | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2019-07-12 |
| 1104482223 | Marne Chelsea Egarton | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2019-05-14 |
| 1730742446 | Derrick Bruce | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2019-04-18 |
| 1669931671 | Asia Bey | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2019-03-19 |
| 1245794452 | Fania L Doxy | Counselor | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2019-01-22 |
| Find all providers in EAST HAZEL CREST | ||||
| City | EAST HAZEL CREST |
| Zip Code | 60429 |
Please comment or provide details below to improve the information on RUSSELL BERGTOLD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.