Provider Demographics
NPI:1407261688
Name:BERGER, JENNIFER HOLLAR (LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HOLLAR
Last Name:BERGER
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:JENNIGER
Other - Middle Name:R
Other - Last Name:HOLLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4855 OAKVIEW LANE NORTH
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442
Mailing Address - Country:US
Mailing Address - Phone:651-276-7549
Mailing Address - Fax:
Practice Address - Street 1:14115 JAMES RD STE 305
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-9417
Practice Address - Country:US
Practice Address - Phone:763-575-8086
Practice Address - Fax:320-774-0415
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303651101YA0400X
MNCC01690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)