Basic Information
| Provider Information | |||||||||
| NPI: | 1326355819 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERMAN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | SACIT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3120 ROSE RD | ||||||||
| Address2: | |||||||||
| City: | MILLADORE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544549713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154595116 | ||||||||
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| Practice Location | |||||||||
| Address1: | N6520 GUY RD | ||||||||
| Address2: | |||||||||
| City: | BLACK RIVER FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546155405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083551240 | ||||||||
| FaxNumber: | 6083567152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2010 | ||||||||
| LastUpdateDate: | 09/07/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 15530-130 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.