Basic Information
| Provider Information | |||||||||
| NPI: | 1114230067 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | CLINICAL DIETICIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 541 DONALD DR SW | ||||||||
| Address2: | |||||||||
| City: | NEW PHILADELPHIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446637203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303393234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 819 N 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DENNISON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446211003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409222800 | ||||||||
| FaxNumber: | 7409226945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2010 | ||||||||
| LastUpdateDate: | 07/21/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | LD.3217 | OH | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.