Provider Demographics
NPI:1487060257
Name:HALL, JORDONNA (LCPC)
Entity type:Individual
Prefix:
First Name:JORDONNA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 BEAR CLAW WAY
Mailing Address - Street 2:#303
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2763
Mailing Address - Country:US
Mailing Address - Phone:217-621-5583
Mailing Address - Fax:
Practice Address - Street 1:6314 ODANA RD
Practice Address - Street 2:SUITE 33
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1129
Practice Address - Country:US
Practice Address - Phone:217-621-5583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008352101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional