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General NPI Number Information
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NPI Number | 1942528740
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Entity Type | Individual
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Provider Name | MICHAEL HALL LICSW
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Gender | Male
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 2127 COUNTY ROAD D E STE A100
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City | MAPLEWOOD
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State | MN
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Zip | 55109-5350
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Country | US
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Telephone | 651-592-1592
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Fax | 651-429-2988
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Provider Business Mailing Address
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Address Line | 2127 COUNTY ROAD D E STE A100
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City | MAPLEWOOD
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State | MN
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Zip | 55109-5350
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Country | US
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Telephone | 651-592-1592
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Fax | 651-429-2988
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 17023
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License Number State | FM
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