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General NPI Number Information
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NPI Number | 1770714891
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Entity Type | Organization
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Legal Business Name | JUDITH ROES HAMMERLE, PH.D., LLC
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 1183 GLENDALE AVE
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City | ADRIAN
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State | MI
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Zip | 49221-1306
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Country | US
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Telephone | 517-260-1762
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Fax | 517-265-2853
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Provider Business Mailing Address
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Address Line | 1183 GLENDALE AVE
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City | ADRIAN
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State | MI
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Zip | 49221-1306
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Country | US
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Telephone | 517-260-1762
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Fax | 517-265-2853
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | JUDITH ROES HAMMERLE
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Credential | PH.D.
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Telephone | 517-260-1762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301002085
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License Number State | MI
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