Provider Demographics
NPI:1336804145
Name:HERMANN, CORY DAVID (LPCC (MN) LPC (WI))
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:DAVID
Last Name:HERMANN
Suffix:
Gender:M
Credentials:LPCC (MN) LPC (WI)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 544
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-0544
Mailing Address - Country:US
Mailing Address - Phone:507-513-5552
Mailing Address - Fax:
Practice Address - Street 1:1109 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-3138
Practice Address - Country:US
Practice Address - Phone:507-513-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02156101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional