Provider Demographics
NPI:1215373428
Name:HERMAN, BRAD (LADC)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:HERMAN
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 EDINBOROUGH WAY
Mailing Address - Street 2:#5312
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5615
Mailing Address - Country:US
Mailing Address - Phone:612-233-0797
Mailing Address - Fax:
Practice Address - Street 1:7400 EDINBOROUGH WAY
Practice Address - Street 2:#5312
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5615
Practice Address - Country:US
Practice Address - Phone:612-233-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302934101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)