Provider Demographics
NPI:1356456248
Name:HAMMOND, MARK R (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:R
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:222 AUBURN ST
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-6004
Mailing Address - Country:US
Mailing Address - Phone:207-797-8255
Mailing Address - Fax:207-797-5560
Practice Address - Street 1:222 AUBURN ST
Practice Address - Street 2:SUITE 1G
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6004
Practice Address - Country:US
Practice Address - Phone:207-797-8255
Practice Address - Fax:200-779-7556
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MESP131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010512139OtherTAX ID
ME130820099Medicaid
MEAA28449OtherHARVARD PILGRIM ID
ME018316OtherANTHEM ID