Healthcare Provider Details

I. General information

NPI: 1508983099
Provider Name (Legal Business Name): CLIFFORD HARTMAN ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 3RD AVE SW
ALBANY OR
97321-2272
US

IV. Provider business mailing address

4516 46TH AVE NE
SALEM OR
97305-3105
US

V. Phone/Fax

Practice location:
  • Phone: 541-967-3866
  • Fax: 541-926-6271
Mailing address:
  • Phone: 503-393-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number747
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: