Provider Demographics
NPI:1396225199
Name:HAMMEL, KRISTEN C
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:C
Last Name:HAMMEL
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 1:1415 COBBLESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-2068
Mailing Address - Country:US
Mailing Address - Phone:217-377-9347
Mailing Address - Fax:
Practice Address - Street 1:7757 US-136
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:IL
Practice Address - Zip Code:61865
Practice Address - Country:US
Practice Address - Phone:217-649-0492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011168101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional