Healthcare Provider Details

I. General information

NPI: 1972442119
Provider Name (Legal Business Name): KRYSTAL CHLOE HAMMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 S GULLEY RD
DEARBORN MI
48124-4405
US

IV. Provider business mailing address

3231 S GULLEY RD
DEARBORN MI
48124-4405
US

V. Phone/Fax

Practice location:
  • Phone: 313-278-3539
  • Fax:
Mailing address:
  • Phone: 313-278-3539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: