Provider Demographics
NPI:1083848915
Name:HALL, RACHELL (LE)
Entity Type:Individual
Prefix:MS
First Name:RACHELL
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 N HAYDEN RD # A106
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2474
Mailing Address - Country:US
Mailing Address - Phone:480-368-9239
Mailing Address - Fax:480-907-2894
Practice Address - Street 1:8320 N HAYDEN RD # A106
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2474
Practice Address - Country:US
Practice Address - Phone:480-368-9239
Practice Address - Fax:480-907-2894
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30600012246Z00000X, 224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ30600012OtherARIZONA STATE BOARD OF COSMETOLOGY