Provider Demographics
NPI:1154509487
Name:HARTMAN, LORETTA ANN
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:ANN
Last Name:HARTMAN
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 1:104 SISTERSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:WV
Mailing Address - Zip Code:26456-1034
Mailing Address - Country:US
Mailing Address - Phone:304-873-2300
Mailing Address - Fax:304-873-2210
Practice Address - Street 1:104 SISTERSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:WV
Practice Address - Zip Code:26456-1034
Practice Address - Country:US
Practice Address - Phone:304-873-2300
Practice Address - Fax:304-873-2210
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0155265000Medicaid