Provider Demographics
NPI:1003095860
Name:HALL, LAURIE (SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 HEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5226
Mailing Address - Country:US
Mailing Address - Phone:904-287-3852
Mailing Address - Fax:
Practice Address - Street 1:1707 HEATHERWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-5226
Practice Address - Country:US
Practice Address - Phone:904-287-3852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist