Healthcare Provider Details

I. General information

NPI: 1326970351
Provider Name (Legal Business Name): DOMINEE R HALL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 ZEBE AVE STE A
POCATELLO ID
83202-4707
US

IV. Provider business mailing address

11417 W WHISPERING CLIFFS DR
POCATELLO ID
83202-5228
US

V. Phone/Fax

Practice location:
  • Phone: 208-339-3580
  • Fax:
Mailing address:
  • Phone: 208-339-3580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DOMINEE R HALL
Title or Position: OWNER
Credential: LCSW
Phone: 208-339-3580