Provider Demographics
NPI:1053488916
Name:HALL, RONALD JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JAMES
Last Name:HALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 GOODING STREET
Mailing Address - Street 2:
Mailing Address - City:LASALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-3678
Mailing Address - Country:US
Mailing Address - Phone:815-224-4522
Mailing Address - Fax:815-223-8055
Practice Address - Street 1:146 GOODING STREET
Practice Address - Street 2:
Practice Address - City:LASALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-3678
Practice Address - Country:US
Practice Address - Phone:815-224-4522
Practice Address - Fax:815-223-8055
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILLCSW1490065071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149006507Medicaid
IL149006507Medicaid
IL373990Medicare PIN