Provider Demographics
NPI:1326355819
Name:HERMAN, STEVEN ALLEN (SACIT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALLEN
Last Name:HERMAN
Suffix:
Gender:M
Credentials:SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 ROSE RD
Mailing Address - Street 2:
Mailing Address - City:MILLADORE
Mailing Address - State:WI
Mailing Address - Zip Code:54454-9713
Mailing Address - Country:US
Mailing Address - Phone:715-459-5116
Mailing Address - Fax:
Practice Address - Street 1:N6520 GUY RD
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-5405
Practice Address - Country:US
Practice Address - Phone:608-355-1240
Practice Address - Fax:608-356-7152
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15530-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)