Provider Demographics
NPI:1700384088
Name:HALL, KATHRYN TERESE
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:TERESE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 S HIGBY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-2831
Mailing Address - Country:US
Mailing Address - Phone:517-748-6629
Mailing Address - Fax:
Practice Address - Street 1:419 4TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2059
Practice Address - Country:US
Practice Address - Phone:517-748-6629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional