Healthcare Provider Details

I. General information

NPI: 1396669677
Provider Name (Legal Business Name): JESSE HAMANN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3436 MARY ELDER RD NE
OLYMPIA WA
98506-5050
US

IV. Provider business mailing address

3436 MARY ELDER RD NE
OLYMPIA WA
98506-5050
US

V. Phone/Fax

Practice location:
  • Phone: 360-528-2590
  • Fax:
Mailing address:
  • Phone: 360-528-2590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: