Healthcare Provider Details

I. General information

NPI: 1093557514
Provider Name (Legal Business Name): MADISON NOEL HARTMAN BSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/08/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 BLACKLICK EASTERN RD
PICKERINGTON OH
43147-8235
US

IV. Provider business mailing address

PO BOX 3103
ZANESVILLE OH
43702-3103
US

V. Phone/Fax

Practice location:
  • Phone: 810-239-8800
  • Fax:
Mailing address:
  • Phone: 740-214-6443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512348
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: