Provider Demographics
NPI:1740471341
Name:HAMMOND, JOANN (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3696 S HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7911
Mailing Address - Country:US
Mailing Address - Phone:208-552-2374
Mailing Address - Fax:208-524-0867
Practice Address - Street 1:1820 E 17TH ST STE 270
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6470
Practice Address - Country:US
Practice Address - Phone:208-552-2374
Practice Address - Fax:208-524-0867
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808038900Medicaid
IDSPF07OtherBLUE CROSS OF IDAHO