Provider Demographics
NPI:1760629737
Name:HERKERT, ANNE G
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:G
Last Name:HERKERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 HIGHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3316
Mailing Address - Country:US
Mailing Address - Phone:815-484-0537
Mailing Address - Fax:
Practice Address - Street 1:802 HIGHVIEW AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3316
Practice Address - Country:US
Practice Address - Phone:815-484-0537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist