Provider Demographics
NPI:1699023028
Name:HERMANN, VICKIE L (LICSW, LLC)
Entity Type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:L
Last Name:HERMANN
Suffix:
Gender:F
Credentials:LICSW, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SE 124TH AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684
Mailing Address - Country:US
Mailing Address - Phone:360-606-9678
Mailing Address - Fax:360-885-4944
Practice Address - Street 1:108 SE 124TH AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684
Practice Address - Country:US
Practice Address - Phone:360-606-9678
Practice Address - Fax:360-885-4944
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 602650481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical