Individual provider Active NPI

Andrea Jo Hermanson, M.S., CCC-SLP

  • Speech-Language Assistant
  • Fitchburg, WI
National Provider Identifier
1356669733
Registry record updated May 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language AssistantTaxonomy code 2355S0801X
License
3353154 Issued in WI
Practice address
2990 Cahill Main
Fitchburg, WI 53711-7130
Phone
(608) 204-6083
NPI assigned
May 11, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Assistant 2355S0801X 3353154 WI Primary

Addresses

Primary practice location

2990 Cahill Main
Fitchburg, WI 53711-7130

Mailing address

5305 Maher Ave
Madison, WI 53716-3225
Phone (608) 444-5104

Other identifiers 1

IdentifierTypeStateIssuer
3353-154OtherWIDEPARTMENT OF REGULATIONS AND LICENSURE

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)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
3353154WIMDSpeech-Language Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273536000000",
    "number": "1356669733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5305 MAHER AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537163225",
            "telephone_number": "608-444-5104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 CAHILL MAIN",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "537117130",
            "telephone_number": "608-204-6083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERMANSON",
        "first_name": "ANDREA",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-11",
        "last_updated": "2010-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "WI",
            "license": "3353154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF REGULATIONS AND LICENSURE",
            "identifier": "3353-154",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fitchburg, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.