Provider Demographics
NPI:1982851812
Name:HARDEMAN, GARY THOMAS (MA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:THOMAS
Last Name:HARDEMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 KANAN RD
Mailing Address - Street 2:#104
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-1100
Mailing Address - Country:US
Mailing Address - Phone:818-991-9832
Mailing Address - Fax:
Practice Address - Street 1:346 KANAN RD
Practice Address - Street 2:#104
Practice Address - City:OAK PARK
Practice Address - State:CA
Practice Address - Zip Code:91377-1100
Practice Address - Country:US
Practice Address - Phone:818-991-9832
Practice Address - Fax:818-991-6616
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist