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General NPI Number Information
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NPI Number | 1609876051
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Entity Type | Organization
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Legal Business Name | HAMM MEMORIAL PSYCHIATRIC CLINIC
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 408 SAINT PETER ST STE 429
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City | SAINT PAUL
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State | MN
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Zip | 55102-1130
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Country | US
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Telephone | 651-224-0614
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Fax | 651-224-5754
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Provider Business Mailing Address
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Address Line | 408 SAINT PETER ST STE 429
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City | SAINT PAUL
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State | MN
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Zip | 55102-1130
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Country | US
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Telephone | 651-224-0614
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Fax | 651-224-5754
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. MARY ELLEN JAEHNE
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Credential | LICSW
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Telephone | 651-224-0614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 800960-1-MHC
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License Number State | MN
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