Provider Demographics
NPI:1376755397
Name:HAMMOND, JAMES R (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3200 SHERIDAN RD
Mailing Address - Street 2:STE 104
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-1921
Mailing Address - Country:US
Mailing Address - Phone:630-674-7881
Mailing Address - Fax:847-310-4690
Practice Address - Street 1:1325 WILEY RD
Practice Address - Street 2:SUITE 165
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4383
Practice Address - Country:US
Practice Address - Phone:630-674-7881
Practice Address - Fax:847-310-4690
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL071-004681103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12007736OtherCAQH
IL313340Medicare ID - Type UnspecifiedMEDICARE
WIWI1203Medicare PIN