Provider Demographics
NPI:1073131157
Name:HALL, MADDISON LOREE
Entity Type:Individual
Prefix:MS
First Name:MADDISON
Middle Name:LOREE
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 1:663 S SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-9674
Mailing Address - Country:US
Mailing Address - Phone:801-989-0470
Mailing Address - Fax:
Practice Address - Street 1:663 S SUNSET DR
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-9674
Practice Address - Country:US
Practice Address - Phone:801-989-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician