Basic Information
| Provider Information | |||||||||
| NPI: | 1477721561 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | WARNER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 E 3RD ST | ||||||||
| Address2: | #201 | ||||||||
| City: | WINONA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559873478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5074527292 | ||||||||
| FaxNumber: | 5074579887 | ||||||||
| Practice Location | |||||||||
| Address1: | 1707 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LA CROSSE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546014200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087850001 | ||||||||
| FaxNumber: | 6087850002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2008 | ||||||||
| LastUpdateDate: | 02/12/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.