Provider Demographics
NPI:1679027957
Name:HAMM, JILLIAN DANIELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:DANIELLE
Last Name:HAMM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:TREFFEISEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:5858 SHALE CT
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9394
Mailing Address - Country:US
Mailing Address - Phone:321-288-9497
Mailing Address - Fax:
Practice Address - Street 1:5858 SHALE CT
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792
Practice Address - Country:US
Practice Address - Phone:321-288-9497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-16-22336103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019714100Medicaid