Provider Demographics
NPI:1164781324
Name:HALLE, SHANE ALEXANDER (HIS)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:ALEXANDER
Last Name:HALLE
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3517
Mailing Address - Country:US
Mailing Address - Phone:304-636-1010
Mailing Address - Fax:304-636-9877
Practice Address - Street 1:307 11TH ST
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3517
Practice Address - Country:US
Practice Address - Phone:304-636-1010
Practice Address - Fax:304-636-9877
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV989237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist