Provider Demographics
NPI:1356669733
Name:HERMANSON, ANDREA JO (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:JO
Last Name:HERMANSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 MAHER AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3225
Mailing Address - Country:US
Mailing Address - Phone:608-444-5104
Mailing Address - Fax:
Practice Address - Street 1:2990 CAHILL MAIN
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7130
Practice Address - Country:US
Practice Address - Phone:608-204-6083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33531542355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3353-154OtherDEPARTMENT OF REGULATIONS AND LICENSURE