Healthcare Provider Details

I. General information

NPI: 1164360657
Provider Name (Legal Business Name): MICHELLE LOUISE HERMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5099 W FARRAND RD
CLIO MI
48420-8215
US

IV. Provider business mailing address

5099 W FARRAND RD
CLIO MI
48420-8215
US

V. Phone/Fax

Practice location:
  • Phone: 586-491-7598
  • Fax:
Mailing address:
  • Phone: 586-491-7598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: