Provider Demographics
NPI:1558051029
Name:HALL, VICTORIA KATHLEEN (MSED, TLMHC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:KATHLEEN
Last Name:HALL
Suffix:
Gender:F
Credentials:MSED, TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WALBRIER CT
Mailing Address - Street 2:
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-9375
Mailing Address - Country:US
Mailing Address - Phone:563-203-0255
Mailing Address - Fax:
Practice Address - Street 1:2435 KIMBERLY RD STE 145N
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3592
Practice Address - Country:US
Practice Address - Phone:563-355-0780
Practice Address - Fax:563-355-0656
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health