Provider Demographics
NPI:1437829199
Name:HALL, SHANNA (RBT)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14465 SW 42ND TERRACE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-2343
Mailing Address - Country:US
Mailing Address - Phone:352-421-2814
Mailing Address - Fax:
Practice Address - Street 1:20785 W MCKINNEY AVE
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34431-6418
Practice Address - Country:US
Practice Address - Phone:352-342-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician