Healthcare Provider Details

I. General information

NPI: 1053920249
Provider Name (Legal Business Name): HAMMOND PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13246 S ROUTE 59 # 102A
PLAINFIELD IL
60585-9800
US

IV. Provider business mailing address

13246 S ROUTE 59 # 102A
PLAINFIELD IL
60585-9800
US

V. Phone/Fax

Practice location:
  • Phone: 630-296-7639
  • Fax:
Mailing address:
  • Phone: 630-296-7639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MELINDA D HAMMOND
Title or Position: OWNER
Credential: PSYD
Phone: 630-296-7639