Provider Demographics
NPI:1659432912
Name:HERZING, DOROTHY M (LICSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:M
Last Name:HERZING
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 E 3RD ST
Mailing Address - Street 2:201
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3478
Mailing Address - Country:US
Mailing Address - Phone:507-452-7292
Mailing Address - Fax:507-457-9887
Practice Address - Street 1:66 E 3RD ST
Practice Address - Street 2:201
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3478
Practice Address - Country:US
Practice Address - Phone:507-452-7292
Practice Address - Fax:507-457-9887
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86771041C0700X
MN00452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN974T8HEOtherBCBS-MN
MN731291012005OtherPREFERRED ONE
MN118046Medicaid
MN529757500Medicaid
MNHP32678OtherHEALTHPARTNERS