Provider Demographics
NPI:1992007603
Name:HALL, KATHRYN JANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:JANE
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2653
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-2653
Mailing Address - Country:US
Mailing Address - Phone:907-531-6047
Mailing Address - Fax:
Practice Address - Street 1:860 S ROBERTS ST # 200
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-0014
Practice Address - Country:US
Practice Address - Phone:079-313-7965
Practice Address - Fax:907-531-3886
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1143891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical