Healthcare Provider Details

I. General information

NPI: 1568771772
Provider Name (Legal Business Name): CHRISTINA JO HARTLINE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA JO HARTLINE PH.D.

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 E DAKOTA AVE
PIERRE SD
57501-3312
US

IV. Provider business mailing address

PO BOX 148
PIERRE SD
57501-0148
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-5811
  • Fax:
Mailing address:
  • Phone: 605-224-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number503
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: