Provider Demographics
NPI:1801787957
Name:HAMMERS, MALLERY A (LICSW)
Entity type:Individual
Prefix:
First Name:MALLERY
Middle Name:A
Last Name:HAMMERS
Suffix:
Gender:X
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3548 GARFIELD AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4719
Mailing Address - Country:US
Mailing Address - Phone:406-570-9646
Mailing Address - Fax:
Practice Address - Street 1:3548 GARFIELD AVE APT 202
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4719
Practice Address - Country:US
Practice Address - Phone:406-570-9646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN245391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical