Provider Demographics
NPI:1063784080
Name:HALL, JEANNE (QBS)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:QBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LOIS LN
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9203
Mailing Address - Country:US
Mailing Address - Phone:440-228-0464
Mailing Address - Fax:
Practice Address - Street 1:30432 EUCLID AVE
Practice Address - Street 2:SUITE #224
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-1578
Practice Address - Country:US
Practice Address - Phone:440-228-0464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X, 247200000X
246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No174400000XOther Service ProvidersSpecialist
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other