Provider Demographics
NPI:1659494169
Name:HALLS, JEFFREY GORDON (BCHIS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:GORDON
Last Name:HALLS
Suffix:
Gender:M
Credentials:BCHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 UNION ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4115
Mailing Address - Country:US
Mailing Address - Phone:413-734-2886
Mailing Address - Fax:413-734-4705
Practice Address - Street 1:425 UNION ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4115
Practice Address - Country:US
Practice Address - Phone:413-734-2886
Practice Address - Fax:413-734-4705
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA29237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1533568Medicaid