Active NPI
Lisa Diane Bergkoetter, MSW
- Social Worker
- Hartland, MI
National Provider Identifier
1407545676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6851114769
- Practice address
- 10635 Dunham Rd
Hartland, MI 48353-1017 - Phone
- (248) 310-4236
- NPI assigned
- May 3, 2023
- Last updated
- May 3, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6851114769 | MI | Primary |
| Clinical Social Worker | 1041C0700X | 6851114769 | MI | |
| School Social Worker | 1041S0200X | 6851114769 | MI |
Addresses
Primary practice location
10635 Dunham Rd
Hartland, MI 48353-1017
Mailing address
10635 Dunham Rd
Hartland, MI 48353-1017
Phone (248) 310-4236
Other names 1
- Lisa Diane Knakal
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6851114769 | MI | MD | School Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683072000000",
"number": "1407545676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10635 DUNHAM RD",
"city": "HARTLAND",
"state": "MI",
"postal_code": "483531017",
"telephone_number": "248-310-4236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10635 DUNHAM RD",
"city": "HARTLAND",
"state": "MI",
"postal_code": "483531017",
"telephone_number": "248-310-4236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGKOETTER",
"first_name": "LISA",
"middle_name": "DIANE",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-03",
"last_updated": "2023-05-03",
"certification_date": "2023-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6851114769",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6851114769",
"primary": false
},
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "MI",
"license": "6851114769",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LISA",
"last_name": "KNAKAL",
"middle_name": "DIANE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Hartland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.