Provider Demographics
NPI:1750778585
Name:HARTMAN, JASON (BCBA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271690
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-5035
Mailing Address - Country:US
Mailing Address - Phone:720-837-2348
Mailing Address - Fax:303-554-5657
Practice Address - Street 1:1406 CENTAUR CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-1432
Practice Address - Country:US
Practice Address - Phone:720-837-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-15-18532103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst