MEDICARE: MRS. MARY ROSE HAMM

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1366047854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ROSE HAMM

Provider Business Mailing Address
First Line	:	6144 KINGSLEY DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2344
Country	:	US
Telephone Number	:	317-919-2326
Fax Number	:

Provider Business Practice Location Address
First Line	:	6239 S EAST ST STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-2088
Country	:	US
Telephone Number	:	260-328-5074
Fax Number	:

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

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/09/2025

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