Healthcare Provider Details

I. General information

NPI: 1780857086
Provider Name (Legal Business Name): ANNE HERMES MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S 4TH ST
OREGON IL
61061-1609
US

IV. Provider business mailing address

519 E 2ND ST
DIXON IL
61021-3101
US

V. Phone/Fax

Practice location:
  • Phone: 815-732-3157
  • Fax: 815-732-3834
Mailing address:
  • Phone: 815-288-6020
  • Fax: 815-284-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: