Provider Demographics
NPI:1255679411
Name:HALL, ROBERT STUART (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STUART
Last Name:HALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:STUART
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5200 CUSTER LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6105
Mailing Address - Country:US
Mailing Address - Phone:406-243-5667
Mailing Address - Fax:406-243-6366
Practice Address - Street 1:1444 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-0001
Practice Address - Country:US
Practice Address - Phone:406-243-5667
Practice Address - Fax:406-243-6366
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT233103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist