Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mi Ja Kang Bergerson, LICSW

Individual provider Clinical Social Worker · NPI 1659086601

Mi Ja Kang Bergerson, LICSW is a Clinical Social Worker in Mound, Minnesota. Qualified in 2018, 8 years ago. Practices with Lyn-Lake Psychotherapy and Wellness Ltd, a 72-clinician group and offers telehealth. Licensed in Minnesota.

Years since qualifying
8
Licensed in
MN
In the registry since
2023
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

See every abbreviation used in this directory →

Practice location Address checks out

2385 Chateau Ln
Mound, MN 55364-1750
Phone: (612) 743-7893
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 28770 (MN)

Record details

NPI number1659086601
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorYes
NPI enumeratedJanuary 13, 2023
Last updated in NPPESJanuary 13, 2023
Certification dateJanuary 13, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Lyn-Lake Psychotherapy And Wellness Ltd — 72 clinicians
Accepts Medicare assignment Not indicated
TelehealthOffers telehealth services

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