Provider Demographics
NPI:1447378856
Name:HERMANSON, JOANNA K (LMP)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:K
Last Name:HERMANSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:JOANNA
Other - Middle Name:K
Other - Last Name:HERMANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:18405 SOUNDVIEW DR NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-9139
Mailing Address - Country:US
Mailing Address - Phone:360-652-2090
Mailing Address - Fax:
Practice Address - Street 1:514 N WEST AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1251
Practice Address - Country:US
Practice Address - Phone:360-435-3052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011947174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist