Provider Demographics
NPI:1497592562
Name:HERMANN, DOMINIC DAVID
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:DAVID
Last Name:HERMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3059 N WEIL ST UNIT 110
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2281
Mailing Address - Country:US
Mailing Address - Phone:414-394-4773
Mailing Address - Fax:
Practice Address - Street 1:N2150 KESAEHKAHTEK RD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:WI
Practice Address - Zip Code:54128-9602
Practice Address - Country:US
Practice Address - Phone:715-799-3835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling