Provider Demographics
NPI:1346375706
Name:HALL, LINDA G (LICSW, LMFT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:G
Last Name:HALL
Suffix:
Gender:F
Credentials:LICSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 PORTLAND AVE
Mailing Address - Street 2:UNIT E
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-7192
Mailing Address - Country:US
Mailing Address - Phone:651-228-0440
Mailing Address - Fax:
Practice Address - Street 1:160 KELLOGG BLVD E
Practice Address - Street 2:SUITE 7000
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1420
Practice Address - Country:US
Practice Address - Phone:651-266-4492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN079141041C0700X
MN0777106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist