Provider Demographics
NPI:1194343004
Name:HAMM, MARCIA GAIL (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:GAIL
Last Name:HAMM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 EAST-WEST RD
Mailing Address - Street 2:
Mailing Address - City:EAST DUMMERSTON
Mailing Address - State:VT
Mailing Address - Zip Code:05346-9651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:503 EAST-WEST RD
Practice Address - Street 2:
Practice Address - City:EAST DUMMERSTON
Practice Address - State:VT
Practice Address - Zip Code:05346-9651
Practice Address - Country:US
Practice Address - Phone:802-257-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0115414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist