Provider Demographics
NPI:1912273558
Name:BERGER, BARBARA ELLEN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ELLEN
Last Name:BERGER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:ELLEN
Other - Last Name:KIESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:8756 WALTON OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1354
Mailing Address - Country:US
Mailing Address - Phone:952-983-0135
Mailing Address - Fax:952-929-8576
Practice Address - Street 1:5353 GAMBLE DRIVE
Practice Address - Street 2:SUITE 160
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1535
Practice Address - Country:US
Practice Address - Phone:952-929-2276
Practice Address - Fax:952-929-8576
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN78061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical