Provider Demographics
NPI:1558714287
Name:HERR, BAO
Entity type:Individual
Prefix:
First Name:BAO
Middle Name:
Last Name:HERR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 TWELVE OAKS CENTER DR
Mailing Address - Street 2:SUITE 822
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-4601
Mailing Address - Country:US
Mailing Address - Phone:952-456-6561
Mailing Address - Fax:952-777-1668
Practice Address - Street 1:801 TWELVE OAKS CENTER DR
Practice Address - Street 2:SUITE 822
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4601
Practice Address - Country:US
Practice Address - Phone:952-456-6561
Practice Address - Fax:952-777-1668
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23658104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker