Provider Demographics
NPI:1184618217
Name:HAMMERLE, JUDITH ROES (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ROES
Last Name:HAMMERLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S MADISON ST
Mailing Address - Street 2:NORTH HALL
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-2518
Mailing Address - Country:US
Mailing Address - Phone:517-260-1762
Mailing Address - Fax:517-265-2853
Practice Address - Street 1:604 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-3215
Practice Address - Country:US
Practice Address - Phone:517-260-1762
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002085103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION52040Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST