Provider Demographics
NPI:1467506725
Name:ANDROES, HERMAN J
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:J
Last Name:ANDROES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3277
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-3277
Mailing Address - Country:US
Mailing Address - Phone:406-752-3413
Mailing Address - Fax:
Practice Address - Street 1:465 LEISURE DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-7587
Practice Address - Country:US
Practice Address - Phone:406-752-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT34103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0490722Medicaid
MT0490722Medicaid