Provider Demographics
NPI:1841484912
Name:HERMES, ESTELLE L (SLP CCC)
Entity type:Individual
Prefix:
First Name:ESTELLE
Middle Name:L
Last Name:HERMES
Suffix:
Gender:F
Credentials:SLP CCC
Other - Prefix:
Other - First Name:ESTELLE
Other - Middle Name:V
Other - Last Name:HERMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP CCC
Mailing Address - Street 1:7 WAMPUS LN
Mailing Address - Street 2:APT 2
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1336
Mailing Address - Country:US
Mailing Address - Phone:203-253-2699
Mailing Address - Fax:203-547-6807
Practice Address - Street 1:7 WAMPUS LN
Practice Address - Street 2:APT 2
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-1336
Practice Address - Country:US
Practice Address - Phone:203-253-2699
Practice Address - Fax:203-547-6807
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001456235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist