Provider Demographics
NPI:1750316550
Name:HERMAN, KIMBERLEE (LISW)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:HERMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 RIVERSIDE DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52411-7412
Mailing Address - Country:US
Mailing Address - Phone:319-431-3930
Mailing Address - Fax:
Practice Address - Street 1:3808 RIVERSIDE DR NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52411-7412
Practice Address - Country:US
Practice Address - Phone:319-431-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11286101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor