Provider Demographics
NPI:1043493521
Name:HASLETT, TAMMY K (PH D)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:K
Last Name:HASLETT
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 BLOOMFIELD ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3268
Mailing Address - Country:US
Mailing Address - Phone:814-266-5238
Mailing Address - Fax:814-266-1762
Practice Address - Street 1:334 BLOOMFIELD ST
Practice Address - Street 2:SUITE 204
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3268
Practice Address - Country:US
Practice Address - Phone:814-266-5238
Practice Address - Fax:814-266-1762
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008994L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA331004OtherHIGHMARK BLUE CROSS
PA0017729510006Medicaid
PA0017729510007Medicaid
PA1025765450004Medicaid
PA1025765450003Medicaid
PA0017729510007Medicaid