Provider Demographics
NPI:1346446325
Name:HALL, BRENDA B
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:B
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 MONCKS CT.
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562
Mailing Address - Country:US
Mailing Address - Phone:252-637-2808
Mailing Address - Fax:
Practice Address - Street 1:3301 TRENT RD
Practice Address - Street 2:A
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5706
Practice Address - Country:US
Practice Address - Phone:252-633-2501
Practice Address - Fax:252-633-2501
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC955235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7438303Medicaid
NC561481722OtherFEDERAL TAX ID