Provider Demographics
NPI:1275710931
Name:SISTERHEN, DANIEL HALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HALL
Last Name:SISTERHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3265 KINGSHOUSE COMMONS
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7611
Mailing Address - Country:US
Mailing Address - Phone:770-751-6992
Mailing Address - Fax:
Practice Address - Street 1:3265 KINGSHOUSE COMMONS
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-7611
Practice Address - Country:US
Practice Address - Phone:770-751-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003083231H00000X
GASLP005188235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist