Provider Demographics
NPI:1477031193
Name:HAMMACK, EMILY ANASTASIA
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANASTASIA
Last Name:HAMMACK
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 1:250 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3048
Mailing Address - Country:US
Mailing Address - Phone:630-769-6564
Mailing Address - Fax:
Practice Address - Street 1:250 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3048
Practice Address - Country:US
Practice Address - Phone:630-769-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist