Provider Demographics
NPI:1093270415
Name:HACKL, KIRSTEN ERNA-STEINFELDT (LMSW)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ERNA-STEINFELDT
Last Name:HACKL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TORREY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3327
Mailing Address - Country:US
Mailing Address - Phone:810-494-7180
Mailing Address - Fax:810-215-1334
Practice Address - Street 1:2200 GENOA BUSINESS PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-5328
Practice Address - Country:US
Practice Address - Phone:810-494-7180
Practice Address - Fax:810-215-1334
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801086888104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker