Provider Demographics
NPI:1730105842
Name:HAMMETT, REBECCA (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:HAMMETT
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 RAYMOND AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1503
Mailing Address - Country:US
Mailing Address - Phone:651-707-3020
Mailing Address - Fax:651-379-0993
Practice Address - Street 1:821 RAYMOND AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1503
Practice Address - Country:US
Practice Address - Phone:651-707-3020
Practice Address - Fax:651-379-0993
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1042966OtherP1
MN113258OtherUC
MN919S4HAOtherBCBS
MN791159900Medicaid
MN48197OtherHP
MN48197OtherHP