Provider Demographics
NPI:1043884513
Name:HALL, SYDNEY JEWEL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:JEWEL
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 1:2808 RUSTY RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-6750
Mailing Address - Country:US
Mailing Address - Phone:478-410-1694
Mailing Address - Fax:
Practice Address - Street 1:2808 RUSTY RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30461-6750
Practice Address - Country:US
Practice Address - Phone:478-410-1694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist