Provider Demographics
NPI:1902101165
Name:HARTKE, BRENT (LISW-S)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:HARTKE
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 KENTUCKY DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2753
Mailing Address - Country:US
Mailing Address - Phone:513-255-1070
Mailing Address - Fax:
Practice Address - Street 1:43 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-1993
Practice Address - Country:US
Practice Address - Phone:513-947-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI09000381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical