Provider Demographics
NPI:1710287818
Name:HALL, PAULA JEAN (RD LDN)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:JEAN
Last Name:HALL
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 CONSTITUTION RD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-2087
Mailing Address - Country:US
Mailing Address - Phone:815-370-5631
Mailing Address - Fax:
Practice Address - Street 1:2025 S CHICAGO ST
Practice Address - Street 2:1051 ESSINGTON RD.
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436-3172
Practice Address - Country:US
Practice Address - Phone:815-726-2200
Practice Address - Fax:815-846-2665
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-24
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.001752133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered