Healthcare Provider Details

I. General information

NPI: 1932027943
Provider Name (Legal Business Name): LINDA HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 N 173RD AVE APT 220
GOODYEAR AZ
85338-1842
US

IV. Provider business mailing address

195 N 173RD AVE APT 220
GOODYEAR AZ
85338-1842
US

V. Phone/Fax

Practice location:
  • Phone: 585-957-0598
  • Fax:
Mailing address:
  • Phone: 585-957-0598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberLP053579
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberLP053579
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberLP053579
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberLP053579
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberLP053579
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberLP053579
License Number StateAZ
# 7
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP053579
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: