Individual
MRS. JESSICA L KENNEDY HERRMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LCAC
Contact information
Practice address
9111 BROADWAY, BROADFIELD CENTER SUITE N, MERRILLVILLE, IN 46410-8122
(219) 791-1006
(219) 791-1007
Mailing address
9111 BROADWAY, BROADFIELD CENTER SUITE N, MERRILLVILLE, IN 46410-8122
(219) 791-1006
(219) 791-1007
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
877001276A
IN
1041C0700X
Clinical Social Worker
Primary
34006146A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200264420
GROUP MEDICAID
IN
Enumeration date
09/21/2007
Last updated
01/09/2012
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