MEDICARE: ARIEL J HARTMAN MS CF SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	242005755	IL

General Provider Information

NPI Number	:	1245851062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL J HARTMAN MS CF SLP

Provider Business Mailing Address
First Line	:	2418 N LAWNDALE AVE UNIT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2321
Country	:	US
Telephone Number	:	847-668-5634
Fax Number	:

Provider Business Practice Location Address
First Line	:	2418 N LAWNDALE AVE UNIT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2321
Country	:	US
Telephone Number	:	847-668-5634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2020
Last Update Date	:	09/29/2020

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