Healthcare Provider Details

I. General information

NPI: 1235298415
Provider Name (Legal Business Name): HOLLY ANNE HAMMERSTROM M.S., CCC/A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY ANNE LEICHTNAM

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 PATTERSON RD SUITE 503
GRAND JUNCTION CO
81506
US

IV. Provider business mailing address

425 PATTERSON RD SUITE 503
GRAND JUNCTION CO
81506
US

V. Phone/Fax

Practice location:
  • Phone: 970-245-2400
  • Fax: 970-242-9092
Mailing address:
  • Phone: 970-245-2400
  • Fax: 970-242-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number532
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number7936
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: