Provider Demographics
NPI:1053135004
Name:HAMM, HEATHER M
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:HAMM
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 1:219 W EMMITT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-1182
Mailing Address - Country:US
Mailing Address - Phone:937-544-2222
Mailing Address - Fax:740-912-9483
Practice Address - Street 1:219 W EMMITT AVE STE C
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1182
Practice Address - Country:US
Practice Address - Phone:937-544-2222
Practice Address - Fax:740-912-9483
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)