MEDICARE: JENNIFER HALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	09923769	CO

General Provider Information

NPI Number	:	1720476401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HALL

Provider Business Mailing Address
First Line	:	303 LAFAYETTE ST
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1637
Country	:	US
Telephone Number	:	808-390-0278
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 LAFAYETTE ST
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1637
Country	:	US
Telephone Number	:	808-390-0278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2015
Last Update Date	:	01/02/2015

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Directions to “ JENNIFER HALL ” Practice Location

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