Provider Demographics
NPI:1174655138
Name:HARTMAN, RENEE R (PHD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:R
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11808 NORTHUP WAY
Mailing Address - Street 2:STE W150
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1936
Mailing Address - Country:US
Mailing Address - Phone:425-889-1240
Mailing Address - Fax:425-889-1249
Practice Address - Street 1:11808 NORTHUP WAY
Practice Address - Street 2:STE W150
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1936
Practice Address - Country:US
Practice Address - Phone:425-889-1240
Practice Address - Fax:425-889-1249
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2597103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent