Provider Demographics
NPI:1942914825
Name:HANSEN, BRIDGET MARIE (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MARIE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:MARIE
Other - Last Name:FORST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LGSW
Mailing Address - Street 1:2004 300TH ST
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:56520-9607
Mailing Address - Country:US
Mailing Address - Phone:507-766-3694
Mailing Address - Fax:
Practice Address - Street 1:115 5TH ST N
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1420
Practice Address - Country:US
Practice Address - Phone:218-643-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health