Provider Demographics
NPI:1295297844
Name:HAMMERLUND, ANNALISE (LPC)
Entity type:Individual
Prefix:
First Name:ANNALISE
Middle Name:
Last Name:HAMMERLUND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANNALISE
Other - Middle Name:
Other - Last Name:DE YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LLPC
Mailing Address - Street 1:3232 WOODWARD AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-3038
Mailing Address - Country:US
Mailing Address - Phone:616-644-1400
Mailing Address - Fax:
Practice Address - Street 1:2050 BRETON RD SE STE 104
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5547
Practice Address - Country:US
Practice Address - Phone:616-259-5136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015759101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional