Provider Demographics
NPI:1528629672
Name:HAMMAKER, KANDACE LUCILLE
Entity type:Individual
Prefix:
First Name:KANDACE
Middle Name:LUCILLE
Last Name:HAMMAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KANDACE
Other - Middle Name:LUCILLE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8820 HILLGROVE SOUTHERN RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45390-9019
Mailing Address - Country:US
Mailing Address - Phone:937-564-5410
Mailing Address - Fax:
Practice Address - Street 1:3095 KETTERING BLVD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1983
Practice Address - Country:US
Practice Address - Phone:937-293-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTJ551378171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator