Provider Demographics
NPI:1902050438
Name:HAMMEL, JACINDA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACINDA
Middle Name:C
Last Name:HAMMEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JACEY
Other - Middle Name:
Other - Last Name:HAMMEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1760 S RAMSEY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-7179
Mailing Address - Country:US
Mailing Address - Phone:205-336-1098
Mailing Address - Fax:205-855-0992
Practice Address - Street 1:1760 S RAMSEY DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-7179
Practice Address - Country:US
Practice Address - Phone:205-336-1098
Practice Address - Fax:205-855-0992
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1465103TC0700X
IN20043605A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical