Basic Information
| Provider Information | |||||||||
| NPI: | 1780835710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDMAN | ||||||||
| FirstName: | HOLLIS | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | M.A., FAAA | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 961205 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761611205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177408400 | ||||||||
| FaxNumber: | 8173322304 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 HEMPHILL | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761040000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173324060 | ||||||||
| FaxNumber: | 8173322304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2008 | ||||||||
| LastUpdateDate: | 02/18/2010 | ||||||||
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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 | 231H00000X | 51188 | TX | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | P00660201 | 01 | RAILROAD MEDICARE | OTHER |