Provider Demographics
NPI:1861911398
Name:JENSEN HALLAHAN, PAULA MARIE (MA)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:JENSEN HALLAHAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WESGLEN PKWY
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-5269
Mailing Address - Country:US
Mailing Address - Phone:815-886-7581
Mailing Address - Fax:
Practice Address - Street 1:HERMANSEN ELEMENTARY SCHOOL
Practice Address - Street 2:101 WESGLEN PARKWAY
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60445
Practice Address - Country:US
Practice Address - Phone:815-886-7581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1860880103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty