Provider Demographics
NPI:1033915699
Name:HALL, LILLY
Entity type:Individual
Prefix:
First Name:LILLY
Middle Name:
Last Name:HALL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 E 14TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4710
Mailing Address - Country:US
Mailing Address - Phone:918-605-7006
Mailing Address - Fax:
Practice Address - Street 1:2744 E 14TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4710
Practice Address - Country:US
Practice Address - Phone:918-605-7006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist