Provider Demographics
NPI:1215246640
Name:BERANEK-FORTWENGLER, BONNIE ROSE (LICSW)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:ROSE
Last Name:BERANEK-FORTWENGLER
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 1:15 S MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-3056
Mailing Address - Country:US
Mailing Address - Phone:507-276-8383
Mailing Address - Fax:
Practice Address - Street 1:1324 5TH ST N
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-1514
Practice Address - Country:US
Practice Address - Phone:507-233-1000
Practice Address - Fax:507-233-1198
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN150771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical