Provider Demographics
NPI:1619956430
Name:HAMMER, JOANN MALCOS (AUD CCC)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:MALCOS
Last Name:HAMMER
Suffix:
Gender:F
Credentials:AUD CCC
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:
Other - Last Name:MALCOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:52 BIOMEDICAL EDUCATION BUILDING
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-8016
Mailing Address - Country:US
Mailing Address - Phone:716-829-3980
Mailing Address - Fax:716-829-3974
Practice Address - Street 1:52 BIOMEDICAL EDUCATION BUILDING
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-8016
Practice Address - Country:US
Practice Address - Phone:716-829-3980
Practice Address - Fax:716-829-3974
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0012441231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00576080002OtherBCCB
Q22177Medicare UPIN
RA3063Medicare ID - Type Unspecified