Provider Demographics
NPI:1609876051
Name:HAMM MEMORIAL PSYCHIATRIC CLINIC
Entity Type:Organization
Organization Name:HAMM MEMORIAL PSYCHIATRIC CLINIC
Other - Org Name:HAMM CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:JAEHNE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:651-224-0614
Mailing Address - Street 1:408 SAINT PETER ST
Mailing Address - Street 2:STE 429
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1130
Mailing Address - Country:US
Mailing Address - Phone:651-224-0614
Mailing Address - Fax:651-224-5754
Practice Address - Street 1:408 SAINT PETER ST
Practice Address - Street 2:STE 429
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1130
Practice Address - Country:US
Practice Address - Phone:651-224-0614
Practice Address - Fax:651-224-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN800960-1-MHC261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
23328HAOtherBC/BS
01583Medicare ID - Type Unspecified