Healthcare Provider Details

I. General information

NPI: 1487723763
Provider Name (Legal Business Name): SHELLEY LYNN HAMMES CADC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 STATE ROAD 70
WEBSTER WI
54893-9251
US

IV. Provider business mailing address

2440 4 1/8TH ST.
CUMBERLAND WI
54829
US

V. Phone/Fax

Practice location:
  • Phone: 877-455-1901
  • Fax: 715-349-8528
Mailing address:
  • Phone: 715-822-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1178
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: