Provider Demographics
NPI:1801817077
Name:HERMANN, KAREN S (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:S
Last Name:HERMANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9677 FIREFLY AVE
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49053-9700
Mailing Address - Country:US
Mailing Address - Phone:269-779-5630
Mailing Address - Fax:
Practice Address - Street 1:5955 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8700
Practice Address - Country:US
Practice Address - Phone:269-220-1252
Practice Address - Fax:269-585-6255
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012960103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC96111010Medicare PIN