=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003272659
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOSHIKO HALL PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2016
-----------------------------------------------------
Last Update Date | 01/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1034 S BRENTWOOD BLVD STE 555
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63117-1265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-456-1369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1034 S BRENTWOOD BLVD STE 555
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63117-1265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-582-9955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 2018037203
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------