Basic Information
Provider Information
NPI: 1851927107
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERBER
FirstName: ANDREA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: W175N11120 STONEWOOD DR
Address2:  
City: GERMANTOWN
State: WI
PostalCode: 530224799
CountryCode: US
TelephoneNumber: 8886859522
FaxNumber: 2623455562
Practice Location
Address1: 44 GOOD COUNSEL DR
Address2:  
City: MANKATO
State: MN
PostalCode: 560016599
CountryCode: US
TelephoneNumber: 8004381772
FaxNumber: 2623455562
Other Information
ProviderEnumerationDate: 03/19/2020
LastUpdateDate: 03/19/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/19/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X  Y Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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