Provider Demographics
NPI:1073665352
Name:HERMAN, RANDALL (CSW, MSW)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:
Last Name:HERMAN
Suffix:
Gender:M
Credentials:CSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W20298 STATE ROAD 121
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773-9685
Mailing Address - Country:US
Mailing Address - Phone:715-538-4312
Mailing Address - Fax:715-538-2426
Practice Address - Street 1:W20298 STATE ROAD 121
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-9685
Practice Address - Country:US
Practice Address - Phone:715-538-4312
Practice Address - Fax:715-538-2426
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI919-125104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI919-125OtherLICENSE