Provider Demographics
NPI:1417371055
Name:HARTNER, LINNAYA (MA, CCC-SLP, BCBA)
Entity Type:Individual
Prefix:
First Name:LINNAYA
Middle Name:
Last Name:HARTNER
Suffix:
Gender:F
Credentials:MA, CCC-SLP, BCBA
Other - Prefix:
Other - First Name:LINNAYA
Other - Middle Name:
Other - Last Name:MANGRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP, BCBA
Mailing Address - Street 1:307 N ANN ARBOR ST
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1140
Mailing Address - Country:US
Mailing Address - Phone:616-340-8069
Mailing Address - Fax:
Practice Address - Street 1:2350 WASHTENAW AVE STE 3
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4526
Practice Address - Country:US
Practice Address - Phone:616-340-8069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 103K00000X
MI7101005566235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst