Provider Demographics
NPI:1023989514
Name:HARTLE, MERANDA SUE
Entity type:Individual
Prefix:MISS
First Name:MERANDA
Middle Name:SUE
Last Name:HARTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 HOLLYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:MI
Mailing Address - Zip Code:49756-7954
Mailing Address - Country:US
Mailing Address - Phone:231-268-0007
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 392
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-0392
Practice Address - Country:US
Practice Address - Phone:231-268-0007
Practice Address - Fax:231-525-3170
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician