Provider Demographics
NPI:1679053060
Name:HALL, SHANIECE (MSW)
Entity Type:Individual
Prefix:
First Name:SHANIECE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 STUDEBAKER LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-1964
Mailing Address - Country:US
Mailing Address - Phone:317-627-3493
Mailing Address - Fax:
Practice Address - Street 1:6905 STUDEBAKER LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-1964
Practice Address - Country:US
Practice Address - Phone:317-627-3493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker