Provider Demographics
NPI:1811047491
Name:HALL, MARY JO (LMSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:HALL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MARYJO
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:2806 DAVENPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3734
Mailing Address - Country:US
Mailing Address - Phone:989-393-4242
Mailing Address - Fax:989-790-8037
Practice Address - Street 1:2806 DAVENPORT AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3734
Practice Address - Country:US
Practice Address - Phone:989-393-4242
Practice Address - Fax:989-790-8037
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801063830104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG36069011Medicare PIN