Basic Information
| Provider Information | |||||||||
| NPI: | 1407261688 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERGER | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | HOLLAR | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPCC, LADC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HOLLAR | ||||||||
| OtherFirstName: | JENNIGER | ||||||||
| OtherMiddleName: | R | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4855 OAKVIEW LANE NORTH | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512767549 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14115 JAMES RD STE 305 | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553749417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635758086 | ||||||||
| FaxNumber: | 3207740415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2014 | ||||||||
| LastUpdateDate: | 12/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 303651 | MN | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | CC01690 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.