Provider Demographics
NPI:1790496057
Name:HALL, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328-1317
Mailing Address - Country:US
Mailing Address - Phone:509-382-1164
Mailing Address - Fax:509-382-1166
Practice Address - Street 1:221 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WA
Practice Address - Zip Code:99328-1317
Practice Address - Country:US
Practice Address - Phone:509-382-1164
Practice Address - Fax:509-382-1166
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)