Provider Demographics
NPI:1356436075
Name:HERD, JERRILYN S (LMFT,LCSW)
Entity type:Individual
Prefix:MRS
First Name:JERRILYN
Middle Name:S
Last Name:HERD
Suffix:
Gender:F
Credentials:LMFT,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MICHIGAN AVE.
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-0000
Mailing Address - Country:US
Mailing Address - Phone:574-722-3566
Mailing Address - Fax:574-753-6118
Practice Address - Street 1:1025 MICHIGAN AVE.
Practice Address - Street 2:SUITE 115
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-0000
Practice Address - Country:US
Practice Address - Phone:574-722-3566
Practice Address - Fax:574-753-6118
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002638A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN217810AMedicare ID - Type Unspecified