Basic Information
| Provider Information | |||||||||
| NPI: | 1629449947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARTNETT | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | AS, LCDCII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1212 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436082906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196930631 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1212 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436082906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196930631 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2015 | ||||||||
| LastUpdateDate: | 10/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCDC.141280-2 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.