MEDICARE: LISA RENEE HALL LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	S.0027692	OH

General Provider Information

NPI Number	:	1487039046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA RENEE HALL LSW

Provider Business Mailing Address
First Line	:	2780 AIRPORT DRIVE
Second Line	:	SUITE 100 - BILLING/CREDENTIALING DEPT.
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2289
Country	:	US
Telephone Number	:	614-645-5500
Fax Number	:	614-645-5517

Provider Business Practice Location Address
First Line	:	3781 S HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207
Country	:	US
Telephone Number	:	614-645-3163
Fax Number	:	614-645-5893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2015
Last Update Date	:	05/29/2018

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