Provider Demographics
NPI:1699132167
Name:HAMMER, MELISSA (LLMSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HAMMER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 WAUKONDA
Mailing Address - Street 2:KPEP
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-3142
Mailing Address - Country:US
Mailing Address - Phone:269-876-5201
Mailing Address - Fax:
Practice Address - Street 1:497 WAUKONDA AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-3142
Practice Address - Country:US
Practice Address - Phone:269-876-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010984861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical