Provider Demographics
NPI:1225224678
Name:HARTLEY, DAN E SR (STATE LICENSED HEARI)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:E
Last Name:HARTLEY
Suffix:SR
Gender:M
Credentials:STATE LICENSED HEARI
Other - Prefix:MR
Other - First Name:DAN
Other - Middle Name:E
Other - Last Name:HARTLEY
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:STATE LICENSED HEARI
Mailing Address - Street 1:PO BOX C
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601
Mailing Address - Country:US
Mailing Address - Phone:573-431-2717
Mailing Address - Fax:
Practice Address - Street 1:502 PEVELY MANOR
Practice Address - Street 2:SUITE 1
Practice Address - City:PEVELY
Practice Address - State:MO
Practice Address - Zip Code:63070
Practice Address - Country:US
Practice Address - Phone:636-479-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO894237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist