Provider Demographics
NPI:1114197696
Name:HALL, SARAH KIMBERLY (MS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KIMBERLY
Last Name:HALL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KIMBERLY
Other - Last Name:AGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 ADELE CV
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-2658
Mailing Address - Country:US
Mailing Address - Phone:501-288-7400
Mailing Address - Fax:
Practice Address - Street 1:310 MID CONTINENT PLZ
Practice Address - Street 2:SUITE 185
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1760
Practice Address - Country:US
Practice Address - Phone:501-288-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2998235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166555721Medicaid
AR1114197696OtherBLUE CROSS BLUE SHIELD
AR1114197696OtherUSABLE