Provider Demographics
NPI:1134646938
Name:BERGE, BRENNA S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:S
Last Name:BERGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BRENNA
Other - Middle Name:S
Other - Last Name:HEPPNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 HIGHWAY 2 W STE 10
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2913
Mailing Address - Country:US
Mailing Address - Phone:701-662-1046
Mailing Address - Fax:
Practice Address - Street 1:210 HIGHWAY 2 W STE 10
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2913
Practice Address - Country:US
Practice Address - Phone:701-662-1046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
ND104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical