Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Bergen D Russon

Individual provider Recreation Therapist · NPI 1861952913

Bergen D Russon is a Recreation Therapist in South Jordan, Utah. Licensed in Utah. Registered with an NPI since 2019.

Licensed in
UT
In the registry since
2019

Practice location Address checks out

11175 S Redwood Rd
South Jordan, UT 84095-8208
Phone: (801) 359-4600
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Recreation Therapist (primary) Taxonomy 225800000X · Licence 11046853-4002 (UT)

Record details

NPI number1861952913
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 24, 2019
Last updated in NPPESMarch 24, 2019
Mailing address11175 S Redwood Rd, South Jordan, UT 84095-8208

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