Provider Demographics
NPI:1083769319
Name:HALL, KATHERINE A (BSSW, LSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:BSSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 543
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-0543
Mailing Address - Country:US
Mailing Address - Phone:419-355-8679
Mailing Address - Fax:
Practice Address - Street 1:733 COUNTY ROAD 100
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-9727
Practice Address - Country:US
Practice Address - Phone:419-355-8679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-0026106104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker