Provider Demographics
NPI:1144747171
Name:HARTMAN, KARA AMBER (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:AMBER
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:KARA
Other - Middle Name:AMBER
Other - Last Name:WELLONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:B S
Mailing Address - Street 1:25 BEAUMONT PL
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1308
Mailing Address - Country:US
Mailing Address - Phone:419-236-1873
Mailing Address - Fax:
Practice Address - Street 1:755 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804
Practice Address - Country:US
Practice Address - Phone:419-996-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH13157OtherOHIO BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY