Provider Demographics
NPI:1457732828
Name:HAMMON, BRAELYNE MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:BRAELYNE
Middle Name:MARIE
Last Name:HAMMON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9816 N FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-9779
Mailing Address - Country:US
Mailing Address - Phone:509-590-6871
Mailing Address - Fax:
Practice Address - Street 1:9816 N FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-9779
Practice Address - Country:US
Practice Address - Phone:509-590-6871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW71644101YM0800X
CAY2862914225400000X
WAHAMMOBM073KL390200000X
WALW609902641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAZKP 101831434OtherPREMERA BLUE CROSS BLUE SHIELD
WAZKR 600169547OtherPREMERA BLUE CROSS