Provider Demographics
NPI:1073896635
Name:HARTMAN, ANNEMIEKE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANNEMIEKE
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNEMIEKE
Other - Middle Name:INGHAM
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:338 W 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2616
Mailing Address - Country:US
Mailing Address - Phone:541-968-1244
Mailing Address - Fax:
Practice Address - Street 1:338 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2616
Practice Address - Country:US
Practice Address - Phone:541-968-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL6861101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health