Basic Information
Provider Information | |||||||||
NPI: | 1982965539 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HALL | ||||||||
FirstName: | DUNCAN | ||||||||
MiddleName: | WILLIAM | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1000 REMINGTON BLVD | ||||||||
Address2: | SUITE 100 (PMG) | ||||||||
City: | BOLINGBROOK | ||||||||
State: | IL | ||||||||
PostalCode: | 604405114 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6309142417 | ||||||||
FaxNumber: | 6309142499 | ||||||||
Practice Location | |||||||||
Address1: | 16151 WEBER RD | ||||||||
Address2: | SUITE 101 | ||||||||
City: | CREST HILL | ||||||||
State: | IL | ||||||||
PostalCode: | 604030863 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8157737827 | ||||||||
FaxNumber: | 8158382656 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/30/2012 | ||||||||
LastUpdateDate: | 05/30/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149015171 | IL | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.