Basic Information
| Provider Information | |||||||||
| NPI: | 1225216195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRMANN | ||||||||
| FirstName: | KERRY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | AU.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DORFFNER | ||||||||
| OtherFirstName: | KERRY | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | AU.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 39 ALLSMEER DR | ||||||||
| Address2: | |||||||||
| City: | WEST GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193908802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567456353 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1941 LIMESTONE RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198085408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029980300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2008 | ||||||||
| LastUpdateDate: | 04/07/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 41YA00073300 | NJ | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | AT006021 | PA | N | Speech, Language and Hearing Service Providers | Audiologist | 237700000X | 030000231 | DE | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 231H00000X | 020000171 | DE | Y | Speech, Language and Hearing Service Providers | Audiologist | 237700000X | 25MG00111900 | NJ | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.