Provider Demographics
NPI:1427168079
Name:HAMANN, JOHN B (ED D)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:HAMANN
Suffix:
Gender:M
Credentials:ED D
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 425
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-0425
Mailing Address - Country:US
Mailing Address - Phone:715-425-7031
Mailing Address - Fax:715-425-1055
Practice Address - Street 1:258 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-3236
Practice Address - Country:US
Practice Address - Phone:715-425-7031
Practice Address - Fax:715-425-1055
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI371-057103TA0700X, 103TC2200X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39062200Medicaid
MN19G68HAOtherBCBS OF MN
MN19G68HAOtherBCBS OF MN