Provider Demographics
NPI:1609204916
Name:HAMMER, KRISTA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:HAMMER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 REDTAIL RD SUITE 12A
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-0094
Mailing Address - Country:US
Mailing Address - Phone:716-608-2988
Mailing Address - Fax:716-608-2942
Practice Address - Street 1:240 REDTAIL RD SUITE 12A
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1412
Practice Address - Country:US
Practice Address - Phone:716-608-2988
Practice Address - Fax:716-608-2988
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY024455-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program