Provider Demographics
NPI:1467533059
Name:ANN BROUILLETTE HAMMOND, PC
Entity Type:Organization
Organization Name:ANN BROUILLETTE HAMMOND, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:906-282-0655
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0442
Mailing Address - Country:US
Mailing Address - Phone:906-282-0655
Mailing Address - Fax:906-774-9085
Practice Address - Street 1:427 S STEPHENSON AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3458
Practice Address - Country:US
Practice Address - Phone:906-282-0655
Practice Address - Fax:906-774-9085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801070318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty