Provider Demographics
NPI:1356670392
Name:HACKLEMAN, JANET E (RN, MFT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:E
Last Name:HACKLEMAN
Suffix:
Gender:F
Credentials:RN, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24785 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2751
Mailing Address - Country:US
Mailing Address - Phone:909-558-4993
Mailing Address - Fax:909-558-0227
Practice Address - Street 1:24785 STEWART ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2751
Practice Address - Country:US
Practice Address - Phone:909-558-4993
Practice Address - Fax:909-558-0227
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246621163W00000X
CAMFC 16132106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse