Provider Demographics
NPI:1770714891
Name:JUDITH ROES HAMMERLE, PH.D., LLC
Entity type:Organization
Organization Name:JUDITH ROES HAMMERLE, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ROES
Authorized Official - Last Name:HAMMERLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-260-1762
Mailing Address - Street 1:1183 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1306
Mailing Address - Country:US
Mailing Address - Phone:517-260-1762
Mailing Address - Fax:517-265-2853
Practice Address - Street 1:1183 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1306
Practice Address - Country:US
Practice Address - Phone:517-260-1762
Practice Address - Fax:517-265-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002085103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID64517OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI03951OtherPARAMOUNT HEALTH CARE
MI03951OtherPARAMOUNT HEALTH CARE