Healthcare Provider Details

I. General information

NPI: 1962366674
Provider Name (Legal Business Name): RUTHANNE HACKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 1/2 E 6TH AVE
TARENTUM PA
15084-1508
US

IV. Provider business mailing address

303 1/2 E 6TH AVE
TARENTUM PA
15084-1508
US

V. Phone/Fax

Practice location:
  • Phone: 724-448-3547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW-006422-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: