Provider Demographics
NPI:1568483121
Name:HARTMAN, MELODY LYNNE (AUD)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:LYNNE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:MELODY
Other - Middle Name:LYNNE
Other - Last Name:BIGELOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2673 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-6209
Mailing Address - Country:US
Mailing Address - Phone:815-494-4282
Mailing Address - Fax:
Practice Address - Street 1:1253 N. ALPINE ROAD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-2201
Practice Address - Country:US
Practice Address - Phone:779-696-9201
Practice Address - Fax:815-397-9667
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000435231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3536440905001Medicaid
ILK16078Medicare PIN
ILL64003Medicare PIN