Provider Demographics
NPI:1902294747
Name:HALL, JESSICA L
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8337 E 81ST ST APT 1210
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-8051
Mailing Address - Country:US
Mailing Address - Phone:216-937-5454
Mailing Address - Fax:
Practice Address - Street 1:8337 E 81ST ST APT 1210
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-8051
Practice Address - Country:US
Practice Address - Phone:216-937-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-01
Last Update Date:2015-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker