Provider Demographics
NPI:1356593297
Name:HAMMERS, DUSTIN BRADSHAW (PHD)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:BRADSHAW
Last Name:HAMMERS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 W 16TH ST STE 2500
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2280
Practice Address - Country:US
Practice Address - Phone:317-963-7204
Practice Address - Fax:317-963-7211
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY502103G00000X
103G00000X
MI6301014253103G00000X
UT799688-2501103G00000X
IN20043478A103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001540973OtherANTHEM PTAN
IN300050189Medicaid