Provider Demographics
NPI:1740823376
Name:HALL, DEBORAH LEE (LGSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEE
Last Name:HALL
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34373 UNITY AVE
Mailing Address - Street 2:
Mailing Address - City:TAYLORS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55084-1922
Mailing Address - Country:US
Mailing Address - Phone:651-253-7253
Mailing Address - Fax:
Practice Address - Street 1:197 3 1/2 ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:WI
Practice Address - Zip Code:54004-8932
Practice Address - Country:US
Practice Address - Phone:651-253-7253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25596104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker