Provider Demographics
NPI:1679727200
Name:DONNA HARTIN PC
Entity type:Organization
Organization Name:DONNA HARTIN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M B
Authorized Official - Last Name:HARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP/L
Authorized Official - Phone:847-612-9627
Mailing Address - Street 1:4444 N WOLCOTT AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5842
Mailing Address - Country:US
Mailing Address - Phone:847-612-9627
Mailing Address - Fax:773-907-9138
Practice Address - Street 1:4444 N. WOLCOTT AVE.
Practice Address - Street 2:UNIT 1B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5842
Practice Address - Country:US
Practice Address - Phone:847-612-9627
Practice Address - Fax:773-907-9138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty