Provider Demographics
NPI:1104993781
Name:GREGERSON, NANCY LYNN (LPCC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LYNN
Last Name:GREGERSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2538
Mailing Address - Country:US
Mailing Address - Phone:507-663-1638
Mailing Address - Fax:
Practice Address - Street 1:818 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2538
Practice Address - Country:US
Practice Address - Phone:507-663-1638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62-92163OtherMEDICA PROVIDER NO.