Provider Demographics
NPI:1457558264
Name:HARTMAN, LINDA KELLEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:KELLEY
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:ALISE
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:11219 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9405
Mailing Address - Country:US
Mailing Address - Phone:616-260-3013
Mailing Address - Fax:
Practice Address - Street 1:11219 BROWN AVE STE C
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-9454
Practice Address - Country:US
Practice Address - Phone:616-865-3678
Practice Address - Fax:616-892-1222
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000074235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist