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

Jeffrey Robert Bergstrom, MSWLCSWMPA

Individual provider Clinical Social Worker · NPI 1558840850

Jeffrey Robert Bergstrom, MSWLCSWMPA is a Clinical Social Worker in Mullan, Idaho. Practices as a sole proprietor. Licensed in California, Hawaii, Idaho and Montana.

Licensed in
CA, HI, ID, MT
In the registry since
2018
Specialties on file
4

Practice location Address checks out

379 2nd St
Mullan, ID 83846
Phone: (307) 264-0114
Show map & directions

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

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 40757 (ID)
Clinical Social Worker Taxonomy 1041C0700X · Licence 100963 (CA)
Clinical Social Worker Taxonomy 1041C0700X · Licence 4686 (HI)
Clinical Social Worker Taxonomy 1041C0700X · Licence 49993 (MT)

Record details

NPI number1558840850
Entity typeIndividual (Type 1)
GenderMale
Credentials MSWLCSWMPA
Sole proprietorYes
NPI enumeratedAugust 8, 2018
Last updated in NPPESDecember 27, 2024
Certification dateDecember 19, 2024