Provider Demographics
NPI:1073034278
Name:HARTZOG, MICHELLE H
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:H
Last Name:HARTZOG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 FALKIRK DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1025
Mailing Address - Country:US
Mailing Address - Phone:919-482-9847
Mailing Address - Fax:
Practice Address - Street 1:783 DOCTORS CT STE C
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4575
Practice Address - Country:US
Practice Address - Phone:336-597-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist