Healthcare Provider Details

I. General information

NPI: 1619942638
Provider Name (Legal Business Name): LINDA HARTMANN PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 MACK RD
FAIRFIELD OH
45014-5130
US

IV. Provider business mailing address

2810 MACK RD
FAIRFIELD OH
45014-5130
US

V. Phone/Fax

Practice location:
  • Phone: 513-874-4530
  • Fax: 513-346-3811
Mailing address:
  • Phone: 513-874-4530
  • Fax: 513-346-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4579
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4579
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: