Provider Demographics
NPI:1407375298
Name:HAMMER, SHARON ROSA (LPC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ROSA
Last Name:HAMMER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 N NICKLAUS LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5358
Mailing Address - Country:US
Mailing Address - Phone:312-965-0245
Mailing Address - Fax:
Practice Address - Street 1:770 N NICKLAUS LN
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5358
Practice Address - Country:US
Practice Address - Phone:312-965-0245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health