Provider Demographics
NPI:1851447619
Name:HALL, CAROLEE ANNE (LM CPM)
Entity Type:Individual
Prefix:MRS
First Name:CAROLEE
Middle Name:ANNE
Last Name:HALL
Suffix:
Gender:F
Credentials:LM CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 PACIFIC AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4753
Mailing Address - Country:US
Mailing Address - Phone:360-459-7222
Mailing Address - Fax:360-459-7223
Practice Address - Street 1:2120 PACIFIC AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4753
Practice Address - Country:US
Practice Address - Phone:360-459-7222
Practice Address - Fax:360-459-7223
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW302176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8440919Medicaid