Provider Demographics
NPI:1255684205
Name:HARTMAN, CRAIG (MHS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CLOVERLEAF MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4190
Mailing Address - Country:US
Mailing Address - Phone:636-485-1432
Mailing Address - Fax:
Practice Address - Street 1:105 CLOVERLEAF MEADOWS CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4190
Practice Address - Country:US
Practice Address - Phone:636-485-1432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4846002Medicare PIN