MEDICARE: MRS. SUZANNE MARIE HARTMAN PSYCHOLOGIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	KY-0094	KY

General Provider Information

NPI Number	:	1710207824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE MARIE HARTMAN PSYCHOLOGIST

Provider Business Mailing Address
First Line	:	13804 LAKE POINT CIR
Second Line	:	SUITE 101
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4238
Country	:	US
Telephone Number	:	502-245-7258
Fax Number	:	502-245-7259

Provider Business Practice Location Address
First Line	:	13804 LAKE POINT CIR
Second Line	:	SUITE 101
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4238
Country	:	US
Telephone Number	:	502-245-7258
Fax Number	:	502-245-7259

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2010
Last Update Date	:	03/21/2012

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