Provider Demographics
NPI:1780835710
Name:HARDMAN, HOLLIS DIANE (MA, FAAA)
Entity Type:Individual
Prefix:
First Name:HOLLIS
Middle Name:DIANE
Last Name:HARDMAN
Suffix:
Gender:F
Credentials:MA, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-332-2304
Practice Address - Street 1:901 HEMPHILL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-0000
Practice Address - Country:US
Practice Address - Phone:817-332-4060
Practice Address - Fax:817-332-2304
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51188231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00660201OtherRAILROAD MEDICARE