Healthcare Provider Details

I. General information

NPI: 1962726679
Provider Name (Legal Business Name): BARBARA ANNA HERMANN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CLUB RD STE 120
EUGENE OR
97401-2439
US

IV. Provider business mailing address

66 CLUB RD STE 120
EUGENE OR
97401-2439
US

V. Phone/Fax

Practice location:
  • Phone: 541-393-5983
  • Fax: 541-393-5984
Mailing address:
  • Phone: 541-393-5983
  • Fax: 541-393-5984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1327
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3221
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048.0058106
License Number StateVT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: