Provider Demographics
NPI:1346855913
Name:HALL, NATOSHA DEONDRA NICKOLE
Entity Type:Individual
Prefix:
First Name:NATOSHA
Middle Name:DEONDRA NICKOLE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24355 GARDEN DR APT 112
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2444
Mailing Address - Country:US
Mailing Address - Phone:216-630-8529
Mailing Address - Fax:
Practice Address - Street 1:1087 E 67TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-1725
Practice Address - Country:US
Practice Address - Phone:216-630-8529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNONEMedicaid