Provider Demographics
NPI:1215250899
Name:HALL, SEAN D (BCABA)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:D
Last Name:HALL
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5827 SE CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1457
Mailing Address - Country:US
Mailing Address - Phone:503-943-0779
Mailing Address - Fax:503-943-0779
Practice Address - Street 1:5827 SE CLINTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-1457
Practice Address - Country:US
Practice Address - Phone:503-943-0779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0-09-3685OtherCERTIFICATION NUMBER