MEDICARE: KRISTIN DAWN HAMMERSLEY LCSW

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	1041C0700X	Clinical Social Worker	149.009687	IL

General Provider Information

NPI Number	:	1194665794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN DAWN HAMMERSLEY LCSW

Provider Business Mailing Address
First Line	:	12084 DEER RUN RD
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-8944
Country	:	US
Telephone Number	:	618-694-4809
Fax Number	:

Provider Business Practice Location Address
First Line	:	12084 DEER RUN RD
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-8944
Country	:	US
Telephone Number	:	618-694-4809
Fax Number	:

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

Provider Enumeration Date	:	03/31/2026
Last Update Date	:	03/31/2026

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