Provider Demographics
NPI:1184719189
Name:HERMAN, LAIL L (PHD)
Entity type:Individual
Prefix:DR
First Name:LAIL
Middle Name:L
Last Name:HERMAN
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 1:1051 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2112
Mailing Address - Country:US
Mailing Address - Phone:847-446-5383
Mailing Address - Fax:847-446-5389
Practice Address - Street 1:1051 CHERRY ST
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2112
Practice Address - Country:US
Practice Address - Phone:847-446-5383
Practice Address - Fax:847-446-5389
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003656103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL924040Medicare ID - Type Unspecified