Provider Demographics
NPI:1730993056
Name:HAMMER, CAROLYN HUNTSMAN
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:HUNTSMAN
Last Name:HAMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3652 AUTUMNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-8362
Mailing Address - Country:US
Mailing Address - Phone:208-521-1096
Mailing Address - Fax:
Practice Address - Street 1:101 E MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-2017
Practice Address - Country:US
Practice Address - Phone:208-357-3104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional