Provider Demographics
NPI:1477017051
Name:HAMANN, TARA ELIZABETH
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ELIZABETH
Last Name:HAMANN
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:PO BOX 3646
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-3646
Mailing Address - Country:US
Mailing Address - Phone:217-223-0413
Mailing Address - Fax:
Practice Address - Street 1:4409 MAINE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5849
Practice Address - Country:US
Practice Address - Phone:217-223-0413
Practice Address - Fax:217-223-0461
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL180013849101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health