Provider Demographics
NPI:1932331386
Name:HERMAN, HEIDI CUNNINGHAM (LMSW)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:CUNNINGHAM
Last Name:HERMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-2749
Mailing Address - Country:US
Mailing Address - Phone:517-605-1092
Mailing Address - Fax:517-263-6090
Practice Address - Street 1:2558 DINIUS RD
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286
Practice Address - Country:US
Practice Address - Phone:517-605-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010892521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801089252OtherMICHIGAN DEPARTMENT OF LICENSURE & REGULATORY AFFAIRS BOARD OF SOCIAL WORK