Provider Demographics
NPI:1821812975
Name:HALL, JENNIFER (BS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14904-1458
Mailing Address - Country:US
Mailing Address - Phone:607-258-5935
Mailing Address - Fax:607-735-5696
Practice Address - Street 1:310 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14904-1458
Practice Address - Country:US
Practice Address - Phone:607-258-5935
Practice Address - Fax:607-735-5696
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator