Healthcare Provider Details

I. General information

NPI: 1972053270
Provider Name (Legal Business Name): JESSICA HALL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 E 16TH AVE
AURORA CO
80045-2545
US

IV. Provider business mailing address

675 N SAINT CLAIR ST SUITE 20-100
CHICAGO IL
60611-5975
US

V. Phone/Fax

Practice location:
  • Phone: 970-848-9111
  • Fax: 970-848-5157
Mailing address:
  • Phone: 312-695-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.018592
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09925096
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: