Healthcare Provider Details

I. General information

NPI: 1558869867
Provider Name (Legal Business Name): NANCY HALL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NANCY WILDHAGEN

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 34TH AVE
CINCINNATI OH
45209-1630
US

IV. Provider business mailing address

4117 34TH AVE
CINCINNATI OH
45209-1630
US

V. Phone/Fax

Practice location:
  • Phone: 513-400-6099
  • Fax:
Mailing address:
  • Phone: 513-400-6099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2002794
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2002794
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: