Healthcare Provider Details

I. General information

NPI: 1518404649
Provider Name (Legal Business Name): BROOKE HAMMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 8TH ST S
MOORHEAD MN
56560-3606
US

IV. Provider business mailing address

1201 25TH ST S
FARGO ND
58103-2311
US

V. Phone/Fax

Practice location:
  • Phone: 701-451-4811
  • Fax: 651-925-0057
Mailing address:
  • Phone: 701-451-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3894
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: