Provider Demographics
NPI:1629035324
Name:HAMMER, MICHAEL L (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:HAMMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 4TH ST
Mailing Address - Street 2:PATHWAY CLINIC SC
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578
Mailing Address - Country:US
Mailing Address - Phone:608-643-3663
Mailing Address - Fax:608-643-5014
Practice Address - Street 1:560 4TH ST
Practice Address - Street 2:PATHWAY CLINIC SC
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578
Practice Address - Country:US
Practice Address - Phone:608-643-3663
Practice Address - Fax:608-643-5014
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1828103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39107900Medicaid