Active NPI
Marion Villahermosa Hermitanio
- Speech-Language Pathologist
- Green Bay, WI
National Provider Identifier
1104754019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 922209
- Practice address
- 539 Laverne Dr
Green Bay, WI 54311-5720 - Phone
- (920) 391-2410
- NPI assigned
- May 11, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 922209 | WI | Primary |
Addresses
Primary practice location
539 Laverne Dr
Green Bay, WI 54311-5720
Mailing address
2259 Red Tail GLN
De Pere, WI 54115-1631
Phone (920) 664-1575
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 922209 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1778457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778457600000",
"number": "1104754019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2259 RED TAIL GLN",
"city": "DE PERE",
"state": "WI",
"postal_code": "541151631",
"telephone_number": "920-664-1575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "539 LAVERNE DR",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543115720",
"telephone_number": "920-391-2410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERMITANIO",
"first_name": "MARION",
"middle_name": "VILLAHERMOSA",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-05-11",
"last_updated": "2026-05-11",
"certification_date": "2026-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "922209",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.