Provider Demographics
NPI:1578845848
Name:BERGLAND, HANNAH (MSW)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:BERGLAND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HOLYOKE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672-5262
Mailing Address - Country:US
Mailing Address - Phone:703-466-0028
Mailing Address - Fax:
Practice Address - Street 1:120 HOLYOKE ST
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672-5262
Practice Address - Country:US
Practice Address - Phone:703-466-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0076971041C0700X
MD185421041C0700X
VA09040081501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical