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General NPI Number Information
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NPI Number | 1053814780
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Entity Type | Individual
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Provider Name | TARA HERRMANN LICSW
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Gender | Female
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 7101 YORK AVE S STE 317
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City | EDINA
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State | MN
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Zip | 55435-4469
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Country | US
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Telephone | 763-703-4215
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Fax |
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Provider Business Mailing Address
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Address Line | 5457 HORIZON DR NE
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City | FRIDLEY
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State | MN
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Zip | 55421-1156
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Country | US
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Telephone | 218-298-0689
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 306272
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 20695
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License Number State | MN
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