Provider Demographics
NPI:1780411900
Name:HAMMONS, JORDAN MATTHEW
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MATTHEW
Last Name:HAMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 8TH ST S RM 115 BROWN HALL
Mailing Address - Street 2:ST CLOUD STATE UNIVERSITY
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301
Mailing Address - Country:US
Mailing Address - Phone:320-308-3830
Mailing Address - Fax:320-308-3831
Practice Address - Street 1:151 8TH ST S RM 115 BROWN HALL
Practice Address - Street 2:ST CLOUD STATE UNIVERSITY
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301
Practice Address - Country:US
Practice Address - Phone:320-308-3830
Practice Address - Fax:320-308-3831
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician