Provider Demographics
NPI:1174069488
Name:HALL, MAUREEN
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 VOLLMER RD STE 119
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2040
Mailing Address - Country:US
Mailing Address - Phone:708-914-2005
Mailing Address - Fax:708-914-2008
Practice Address - Street 1:3235 VOLLMER RD STE 119
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2040
Practice Address - Country:US
Practice Address - Phone:708-914-2005
Practice Address - Fax:708-914-2008
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL36817276400000X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit