Provider Demographics
NPI:1023265105
Name:HERTLEIN, BRIGETTE LEE (MSW)
Entity type:Individual
Prefix:MISS
First Name:BRIGETTE
Middle Name:LEE
Last Name:HERTLEIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:BRIGETTE
Other - Middle Name:LEE
Other - Last Name:MAAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:35 MAIN PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0715
Mailing Address - Country:US
Mailing Address - Phone:712-352-2110
Mailing Address - Fax:
Practice Address - Street 1:35 MAIN PL
Practice Address - Street 2:SUITE 100
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0715
Practice Address - Country:US
Practice Address - Phone:712-352-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA066691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical