MEDICARE: KELSEY HAMMON M.A., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	25654	CA

General Provider Information

NPI Number	:	1063072510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY HAMMON M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	3043 PUTNAM BLVD
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-4627
Country	:	US
Telephone Number	:	925-322-1379
Fax Number	:

Provider Business Practice Location Address
First Line	:	3043 PUTNAM BLVD
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-4627
Country	:	US
Telephone Number	:	925-322-1379
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2019
Last Update Date	:	06/17/2019

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