Basic Information
| Provider Information | |||||||||
| NPI: | 1295782191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMM | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LSCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DREILING | ||||||||
| OtherFirstName: | NANCY | ||||||||
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| OtherCredential: | LSCSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 635 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672033602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166607600 | ||||||||
| FaxNumber: | 3163837925 | ||||||||
| Practice Location | |||||||||
| Address1: | 1919 N AMIDON AVE | ||||||||
| Address2: | STE. 130 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672032117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166607675 | ||||||||
| FaxNumber: | 3168321571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2299 | KS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 7155 | 01 | KS | PREFERRED HEALTH SYSTEMS | OTHER | P00050934 | 01 | KS | RAILROAD MEDICARE | OTHER | 069861 | 01 | KS | BLUE CROSS | OTHER |