Provider Demographics
NPI:1437932134
Name:HALL, JESSICA GAIL
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:GAIL
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 1:12710 W 121ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2271
Mailing Address - Country:US
Mailing Address - Phone:701-260-6191
Mailing Address - Fax:
Practice Address - Street 1:8220 TRAVIS ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-3937
Practice Address - Country:US
Practice Address - Phone:701-260-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical