Healthcare Provider Details

I. General information

NPI: 1700679776
Provider Name (Legal Business Name): AMANDA NICOLE HARTMAN CRAVEN EDUCATION SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA NICOLE HARTMAN

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MAIN ST STE B
MUNCIE IN
47305-2839
US

IV. Provider business mailing address

13043 W 450 N
LINTON IN
47441-6140
US

V. Phone/Fax

Practice location:
  • Phone: 520-258-8869
  • Fax:
Mailing address:
  • Phone: 520-258-8869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number10285624
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: