Healthcare Provider Details

I. General information

NPI: 1194665794
Provider Name (Legal Business Name): KRISTIN DAWN HAMMERSLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12084 DEER RUN RD
MARION IL
62959-8944
US

IV. Provider business mailing address

12084 DEER RUN RD
MARION IL
62959-8944
US

V. Phone/Fax

Practice location:
  • Phone: 618-694-4809
  • Fax:
Mailing address:
  • Phone: 618-694-4809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.009687
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: