Provider Demographics
NPI:1295887263
Name:HERMAN, KRISTIE ANN (MS-CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:ANN
Last Name:HERMAN
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:MS
Other - First Name:KRISTIE
Other - Middle Name:ANN
Other - Last Name:RAMSEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS-CCC-SLP
Mailing Address - Street 1:202 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1507
Mailing Address - Country:US
Mailing Address - Phone:608-417-6000
Mailing Address - Fax:
Practice Address - Street 1:1414 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-2106
Practice Address - Country:US
Practice Address - Phone:608-417-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2342-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42555100Medicaid
2342-154OtherLICENSE