MEDICARE: JEANNE E HERMANN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1316191232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE E HERMANN

Provider Business Mailing Address
First Line	:	PO BOX 387
Second Line	:
City	:	PLEASANT HOPE
State	:	MO
Zip	:	65725-0387
Country	:	US
Telephone Number	:	417-267-2277
Fax Number	:	417-267-4304

Provider Business Practice Location Address
First Line	:	303 N MAIN ST
Second Line	:
City	:	PLEASANT HOPE
State	:	MO
Zip	:	65725-8108
Country	:	US
Telephone Number	:	417-267-2277
Fax Number	:	417-267-4304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	11/05/2008

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Directions to “ JEANNE E HERMANN ” Practice Location

Language	Start Address	Practice Location

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