Provider Demographics
NPI:1801057500
Name:ANGEL-HARTMAN, MARLO
Entity type:Individual
Prefix:MRS
First Name:MARLO
Middle Name:
Last Name:ANGEL-HARTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 N THORPE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1203
Mailing Address - Country:US
Mailing Address - Phone:719-406-3224
Mailing Address - Fax:
Practice Address - Street 1:1119 N THORPE DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-1203
Practice Address - Country:US
Practice Address - Phone:719-406-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12103664OtherASHA