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NPI Code Detail

MEDICARE: TIFFANY NICOLE HAMM

MEDICARE: TIFFANY NICOLE HAMM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.177955OH
2171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871262691
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY NICOLE HAMM
Provider Business Mailing Address
First Line : 3411 OFFICE PARK DR
Second Line :
City : DAYTON
State : OH
Zip : 45439-2298
Country : US
Telephone Number : 937-802-5440
Fax Number : 937-660-9440
Provider Business Practice Location Address
First Line : 3411 OFFICE PARK DR
Second Line :
City : DAYTON
State : OH
Zip : 45439-2298
Country : US
Telephone Number : 937-802-5440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2021
Last Update Date : 12/20/2024

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Directions to “ TIFFANY NICOLE HAMM ” Practice Location

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