Provider Demographics
NPI:1679350631
Name:HARTJES, DAVID (HIS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:HARTJES
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 SUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6918
Mailing Address - Country:US
Mailing Address - Phone:920-253-1740
Mailing Address - Fax:
Practice Address - Street 1:2030 SUTLER AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6918
Practice Address - Country:US
Practice Address - Phone:920-253-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2037-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist