Provider Demographics
NPI:1699061978
Name:SPEAKES-HALL, EBONY (LISW-S)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:SPEAKES-HALL
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:
Other - Last Name:SPEAKES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6617 ENGLISH OAKS STA
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9262
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6617 ENGLISH OAKS STA
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9262
Practice Address - Country:US
Practice Address - Phone:937-360-1235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1100522104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicaid