Provider Demographics
NPI:1780433086
Name:HALL, SANDRA ANN
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
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 1:4306 JEFF SCOTT DR APT A
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4545
Mailing Address - Country:US
Mailing Address - Phone:254-816-6898
Mailing Address - Fax:
Practice Address - Street 1:4306 JEFF SCOTT DR APT A
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4545
Practice Address - Country:US
Practice Address - Phone:254-816-6898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician