Provider Demographics
NPI:1720842065
Name:ENTRUP-HERRMANN, ANN (MA ART THERAPY)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:ENTRUP-HERRMANN
Suffix:
Gender:F
Credentials:MA ART THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VA BLACK HILLS HEALTH CARE
Mailing Address - Street 2:113 COMANCHE ROAD
Mailing Address - City:FORT MEADE
Mailing Address - State:SD
Mailing Address - Zip Code:57741
Mailing Address - Country:US
Mailing Address - Phone:605-347-2511
Mailing Address - Fax:
Practice Address - Street 1:VA BLACK HILLS HEALTH CARE
Practice Address - Street 2:113 COMANCHE ROAD
Practice Address - City:FORT MEADE
Practice Address - State:SD
Practice Address - Zip Code:57741
Practice Address - Country:US
Practice Address - Phone:605-347-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist