Healthcare Provider Details

I. General information

NPI: 1669732608
Provider Name (Legal Business Name): NANCY JEAN HIRSCHENBERGER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14241 GRAND OAKS DR
BAXTER MN
56425-8749
US

IV. Provider business mailing address

5057 CEDARDALE LN
BAXTER MN
56425-8306
US

V. Phone/Fax

Practice location:
  • Phone: 218-316-3110
  • Fax:
Mailing address:
  • Phone: 218-829-4621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8020
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: