Provider Demographics
NPI:1013571454
Name:HALL, SHELLY R (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:R
Last Name:HALL
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 1:133 CINDER HILL DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-7063
Mailing Address - Country:US
Mailing Address - Phone:912-230-9170
Mailing Address - Fax:
Practice Address - Street 1:133 CINDER HILL DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31523-7063
Practice Address - Country:US
Practice Address - Phone:912-230-9170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist