Provider Demographics
NPI:1710207824
Name:HARTMAN, SUZANNE MARIE (PSYCHOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MARIE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13804 LAKE POINT CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4238
Mailing Address - Country:US
Mailing Address - Phone:502-245-7258
Mailing Address - Fax:502-245-7259
Practice Address - Street 1:13804 LAKE POINT CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4238
Practice Address - Country:US
Practice Address - Phone:502-245-7258
Practice Address - Fax:502-245-7259
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYKY-0094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional