Provider Demographics
NPI:1427610112
Name:HALDERMAN, MINDY ANNE
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:ANNE
Last Name:HALDERMAN
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 1:4704 GOODMAN ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-3670
Mailing Address - Country:US
Mailing Address - Phone:614-668-3442
Mailing Address - Fax:
Practice Address - Street 1:4704 GOODMAN ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3670
Practice Address - Country:US
Practice Address - Phone:614-668-3442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1226175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist