Healthcare Provider Details

I. General information

NPI: 1902593551
Provider Name (Legal Business Name): SHAELOREN BREANNA HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 RIDGES BLVD
GRAND JUNCTION CO
81507
US

IV. Provider business mailing address

397 RIDGES BLVD
GRAND JUNCTION CO
81507
US

V. Phone/Fax

Practice location:
  • Phone: 970-317-7175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: