Basic Information
| Provider Information | |||||||||
| NPI: | 1760775118 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTMANN | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 405 W DOUGLAS ST | ||||||||
| Address2: | BOX 246 | ||||||||
| City: | ONEILL | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687631719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023362800 | ||||||||
| FaxNumber: | 4023362849 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 W DOUGLAS ST | ||||||||
| Address2: | BOX 246 | ||||||||
| City: | ONEILL | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687631719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023362800 | ||||||||
| FaxNumber: | 4023362849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2011 | ||||||||
| LastUpdateDate: | 05/18/2011 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.