Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 11162 | WI |
Y | 1041C0700X | Clinical Social Worker | 3457 | WI |
N | 1041C0700X | Clinical Social Worker | 3457-123 | WI |
NPI | 1013078518 |
---|---|
Provider Name | Daniel E Hermsen |
First Address | Waukesha, WI 53186-1303 |
Second Address | Waukesha, WI 53186-1301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 09/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39385700 | (05) | WI |