Basic Information
| Provider Information | |||||||||
| NPI: | 1235298415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMMERSTROM | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., CCC/A | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LEICHTNAM | ||||||||
| OtherFirstName: | HOLLY | ||||||||
| OtherMiddleName: | ANNE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 425 PATTERSON RD | ||||||||
| Address2: | SUITE 503 | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702452400 | ||||||||
| FaxNumber: | 9702429092 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 PATTERSON RD | ||||||||
| Address2: | SUITE 503 | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702452400 | ||||||||
| FaxNumber: | 9702429092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 01/16/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 7936 | MN | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | 532 | CO | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.