Provider Demographics
NPI:1225588445
Name:HAMLETT, JEANNA
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:HAMLETT
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 1:1772 STEIGER LAKE LN
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-7723
Mailing Address - Country:US
Mailing Address - Phone:952-443-9888
Mailing Address - Fax:952-443-9804
Practice Address - Street 1:1772 STEIGER LAKE LN
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-7723
Practice Address - Country:US
Practice Address - Phone:952-443-9888
Practice Address - Fax:952-443-9804
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105249225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN76842OtherHEALTH PARTNERS
MN001442700Medicaid
MN1311578OtherARAZ/AMERICA'S PPO/CIGNA
MN169036OtherUCARE
MN565581028803OtherPREFERRED ONE
MN78B64KIOtherBCBS
MN16154051OtherPATIENT CARE