Provider Demographics
NPI:1356699045
Name:HALL, JENNIFER REBECCA (LMSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:REBECCA
Last Name:HALL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M351
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-6900
Mailing Address - Fax:269-341-7883
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M351
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-6900
Practice Address - Fax:269-341-7885
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094259104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker