Provider Demographics
NPI:1740952845
Name:ANDRIES, HERMINA (SLP)
Entity type:Individual
Prefix:
First Name:HERMINA
Middle Name:
Last Name:ANDRIES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21293 VINEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FORESTHILL
Mailing Address - State:CA
Mailing Address - Zip Code:95631-9667
Mailing Address - Country:US
Mailing Address - Phone:916-833-2941
Mailing Address - Fax:
Practice Address - Street 1:6508 LONETREE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5885
Practice Address - Country:US
Practice Address - Phone:510-759-7829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP19112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist