Provider Demographics
NPI:1245213685
Name:HAMMACK, JUDITH F (CCC-A)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:F
Last Name:HAMMACK
Suffix:
Gender:F
Credentials:CCC-A
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 486
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-0486
Mailing Address - Country:US
Mailing Address - Phone:601-703-9506
Mailing Address - Fax:601-703-3264
Practice Address - Street 1:2203 HWY 39 N
Practice Address - Street 2:SUITE A, BOX 5
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-2609
Practice Address - Country:US
Practice Address - Phone:601-483-8121
Practice Address - Fax:601-485-6627
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA0010231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770585Medicare ID - Type Unspecified
R34755Medicare UPIN