Provider Demographics
NPI:1528111689
Name:BERNER, ALLYSON HANSON
Entity type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:HANSON
Last Name:BERNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4666 PENKWE WAY
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2752
Mailing Address - Country:US
Mailing Address - Phone:651-330-0883
Mailing Address - Fax:
Practice Address - Street 1:670 NORTH ROBERT STREET
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101
Practice Address - Country:US
Practice Address - Phone:651-224-1329
Practice Address - Fax:651-224-6520
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN169379101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN169379OtherIAPSRS
MN448998500Medicaid