Provider Demographics
NPI:1053041665
Name:HALL, CLARISSA MAUREEN
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:MAUREEN
Last Name:HALL
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 1:601 25TH AVE S FL 7
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1454
Mailing Address - Country:US
Mailing Address - Phone:612-273-9719
Mailing Address - Fax:
Practice Address - Street 1:601 25TH AVE S FL 7
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1454
Practice Address - Country:US
Practice Address - Phone:612-273-9719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS