Provider Demographics
NPI:1013225960
Name:HALLUM, MARY E (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:HALLUM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 STONYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2387
Mailing Address - Country:US
Mailing Address - Phone:615-482-4562
Mailing Address - Fax:
Practice Address - Street 1:8044 COLEY DAVIS RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2310
Practice Address - Country:US
Practice Address - Phone:615-646-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist