Basic Information
Provider Information
NPI: 1003140534
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAMMER
FirstName: SHEILA
MiddleName: LOUISE
NamePrefix:  
NameSuffix:  
Credential: M.S.W., A.S.W.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HALLSTROM
OtherFirstName: SHEILA
OtherMiddleName: LOUISE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 921485
Address2:  
City: SYLMAR
State: CA
PostalCode: 913921485
CountryCode: US
TelephoneNumber: 5593622989
FaxNumber:  
Practice Location
Address1: 318 W CHEVY CHASE DR
Address2: 205
City: GLENDALE
State: CA
PostalCode: 912042254
CountryCode: US
TelephoneNumber: 5593622989
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/30/2009
LastUpdateDate: 09/30/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X26298CAY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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