Provider Demographics
NPI:1306976840
Name:HALL, GERALYN ANN (MSW LCSW LMSW)
Entity type:Individual
Prefix:
First Name:GERALYN
Middle Name:ANN
Last Name:HALL
Suffix:
Gender:F
Credentials:MSW LCSW LMSW
Other - Prefix:
Other - First Name:GERALYN
Other - Middle Name:ANN
Other - Last Name:BIRSCHBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1110 10TH AVE STE L4
Mailing Address - Street 2:
Mailing Address - City:MENOMINEE
Mailing Address - State:MI
Mailing Address - Zip Code:49858-3058
Mailing Address - Country:US
Mailing Address - Phone:906-290-2444
Mailing Address - Fax:
Practice Address - Street 1:1110 10TH AVE STE L4
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858-3058
Practice Address - Country:US
Practice Address - Phone:906-290-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010990081041C0700X
WI43151231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI87071030OtherRN LICENSE
WI39631600Medicaid
WI39631600Medicaid