Basic Information
| Provider Information | |||||||||
| NPI: | 1003158999 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTSHORNE | ||||||||
| FirstName: | JUSTINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NAGEL | ||||||||
| OtherFirstName: | JUSTINE | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MS-CCC-SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 38431 HEMLOCK DR | ||||||||
| Address2: | |||||||||
| City: | FRANKFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199454617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128897208 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 31 HOSIER ST | ||||||||
| Address2: | |||||||||
| City: | SELBYVILLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199759300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024361000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2013 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL010769 | PA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.