Provider Demographics
NPI:1669732608
Name:HIRSCHENBERGER, NANCY JEAN (LICSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JEAN
Last Name:HIRSCHENBERGER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5057 CEDARDALE LN
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8306
Mailing Address - Country:US
Mailing Address - Phone:218-829-4621
Mailing Address - Fax:
Practice Address - Street 1:14241 GRAND OAKS DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8749
Practice Address - Country:US
Practice Address - Phone:218-316-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN80201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical