Provider Demographics
NPI:1316085384
Name:HERMANSON, COLLEEN J (MS SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:J
Last Name:HERMANSON
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-0194
Mailing Address - Country:US
Mailing Address - Phone:701-208-1602
Mailing Address - Fax:
Practice Address - Street 1:126 S MAIN AVE.
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368
Practice Address - Country:US
Practice Address - Phone:701-208-1602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND019015Medicaid