MEDICARE: KIMBERLY 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	146.009182	IL

General Provider Information

NPI Number	:	1891022075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY HERMANN

Provider Business Mailing Address
First Line	:	318 E FLORENCE ST
Second Line	:
City	:	OGLESBY
State	:	IL
Zip	:	61348-1237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 N GREENWOOD ST
Second Line	:
City	:	SPRING VALLEY
State	:	IL
Zip	:	61362-1576
Country	:	US
Telephone Number	:	815-664-5035
Fax Number	:

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

Provider Enumeration Date	:	11/10/2009
Last Update Date	:	11/10/2009

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Directions to “ KIMBERLY HERMANN ” Practice Location

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