Provider Demographics
NPI:1962107482
Name:HALL, ALEXANDRIA (MSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 S SAINT LAWRENCE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-7244
Mailing Address - Country:US
Mailing Address - Phone:708-822-5686
Mailing Address - Fax:
Practice Address - Street 1:6025 S SAINT LAWRENCE AVE APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-7244
Practice Address - Country:US
Practice Address - Phone:708-822-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150104654104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker