Provider Demographics
NPI:1376058685
Name:HALL, KELSEY LOUISE
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LOUISE
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 1:3737 EASTON MARKET # 1348
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-6023
Mailing Address - Country:US
Mailing Address - Phone:614-963-2646
Mailing Address - Fax:614-295-9349
Practice Address - Street 1:747 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-6905
Practice Address - Country:US
Practice Address - Phone:614-963-2646
Practice Address - Fax:614-295-9349
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OHI.21032281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker