Provider Demographics
NPI:1770079980
Name:HIRST, BREANN L (LISW)
Entity type:Individual
Prefix:
First Name:BREANN
Middle Name:L
Last Name:HIRST
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:BREANN
Other - Middle Name:L
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3475 JERSEY RIDGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2293
Mailing Address - Country:US
Mailing Address - Phone:563-949-1114
Mailing Address - Fax:
Practice Address - Street 1:3475 JERSEY RIDGE RD STE 2
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2293
Practice Address - Country:US
Practice Address - Phone:563-949-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086605104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker