Provider Demographics
NPI:1235298415
Name:HAMMERSTROM, HOLLY ANNE (MS, CCC/A)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:ANNE
Last Name:HAMMERSTROM
Suffix:
Gender:F
Credentials:MS, CCC/A
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ANNE
Other - Last Name:LEICHTNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 PATTERSON RD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506
Mailing Address - Country:US
Mailing Address - Phone:970-245-2400
Mailing Address - Fax:970-242-9092
Practice Address - Street 1:425 PATTERSON RD
Practice Address - Street 2:SUITE 503
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506
Practice Address - Country:US
Practice Address - Phone:970-245-2400
Practice Address - Fax:970-242-9092
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7936237600000X
CO532231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter