Provider Demographics
NPI:1760852701
Name:HARTWIG, CLINTEN (LMP)
Entity Type:Individual
Prefix:MR
First Name:CLINTEN
Middle Name:
Last Name:HARTWIG
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 NE 44TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2169
Mailing Address - Country:US
Mailing Address - Phone:360-991-8452
Mailing Address - Fax:
Practice Address - Street 1:3303 NE 44TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2169
Practice Address - Country:US
Practice Address - Phone:360-991-8452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60542561225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist