Healthcare Provider Details

I. General information

NPI: 1720703119
Provider Name (Legal Business Name): HANNAH GRACE HALL CSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 NE 165TH AVE
PORTLAND OR
97230-6148
US

IV. Provider business mailing address

5914 N VANCOUVER AVE
PORTLAND OR
97217-2158
US

V. Phone/Fax

Practice location:
  • Phone: 503-408-8100
  • Fax:
Mailing address:
  • Phone: 205-451-7772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA14068
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: