Provider Demographics
NPI:1083884399
Name:HARTMAN, MARYLOU (MA)
Entity type:Individual
Prefix:
First Name:MARYLOU
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IN
Mailing Address - Zip Code:46747-0124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:608 2ND ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:IN
Practice Address - Zip Code:46747-5426
Practice Address - Country:US
Practice Address - Phone:260-587-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health