Provider Demographics
NPI:1225204365
Name:HALL, WINIFRED JEANETTE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:WINIFRED
Middle Name:JEANETTE
Last Name:HALL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 COTTAGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-4010
Mailing Address - Country:US
Mailing Address - Phone:515-783-0553
Mailing Address - Fax:
Practice Address - Street 1:2812 COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-4010
Practice Address - Country:US
Practice Address - Phone:515-783-0553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA545153000Medicaid