Healthcare Provider Details

I. General information

NPI: 1235943697
Provider Name (Legal Business Name): JORDAN P HAMMES MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CENTRAL AVE STE 250
NORTHFIELD IL
60093-3024
US

IV. Provider business mailing address

20 STARBUCK DR UNIT 120
TROY NY
12183-1268
US

V. Phone/Fax

Practice location:
  • Phone: 847-629-4696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.021246
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: