Healthcare Provider Details

I. General information

NPI: 1275574923
Provider Name (Legal Business Name): DIANA I. HALL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E ALCOTT AVE
FERGUS FALLS MN
56537-2903
US

IV. Provider business mailing address

511 VERNON PL
FERGUS FALLS MN
56537-3135
US

V. Phone/Fax

Practice location:
  • Phone: 218-736-6987
  • Fax: 218-736-6980
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13295
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier62-53394
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerUNITED BEHAVIORAL HEALTH
# 2
IdentifierHP30658
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerHEALTHPARTNERS
# 3
Identifier125515
Identifier TypeOTHER
Identifier StateFM
Identifier IssuerUCARE MINNESOTA
# 4
Identifier325L2BY
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerBLUE SHIELD OF MN
# 5
Identifier1029838
Identifier TypeOTHER
Identifier StateFM
Identifier IssuerPREFERREDONE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: