Healthcare Provider Details

I. General information

NPI: 1356488092
Provider Name (Legal Business Name): JACQUELINE SCOTT HARTMAN M.A.,CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15991 MANCHESTER RD
ELLISVILLE MO
63011-2140
US

IV. Provider business mailing address

15991 MANCHESTER RD
ELLISVILLE MO
63011-2140
US

V. Phone/Fax

Practice location:
  • Phone: 636-394-4240
  • Fax:
Mailing address:
  • Phone: 636-394-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number536
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number536
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number536
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number624
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number624
License Number StateMO
# 6
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number536
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: