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General NPI Number Information
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NPI Number | 1982851812
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Entity Type | Individual
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Provider Name | GARY THOMAS HARDEMAN M.A.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 346 KANAN RD #104
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City | OAK PARK
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State | CA
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Zip | 91377-1100
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Country | US
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Telephone | 818-991-9832
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Fax | 818-991-6616
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Provider Business Mailing Address
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Address Line | 346 KANAN RD #104
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City | OAK PARK
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State | CA
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Zip | 91377-1100
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Country | US
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Telephone | 818-991-9832
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP3312
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License Number State | CA
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