Provider Demographics
NPI:1336602176
Name:HAMMON, PRISCILLA (LMSW)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:HAMMON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-2013
Mailing Address - Country:US
Mailing Address - Phone:618-978-5642
Mailing Address - Fax:
Practice Address - Street 1:88 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1415
Practice Address - Country:US
Practice Address - Phone:618-288-8085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.102808104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker